21D0220436 CLIA NUMBER - MARYLAND PRIMARY CARE PHYSICIAN LLC

Laboratory Demographics

  • CLIA Code: 21D0220436
  • Facility Name: MARYLAND PRIMARY CARE PHYSICIAN LLC
  • Facility Address: 125 SHOREWAY DRIVE SUITE 120
    QUEENSTOWN, MD
    ZIP 21658
  • Facility Phone: 410 827-4001
  • Facility Type: Physician Office
  • Facility Type: Microscopy
  • Lab Director: TIMOTHY M. KLEPPER
  • NPI Number: 1588486526
  • Taxonomy: 261QP2300X - Clinic/Center

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CLIA Record

Field Name Field Value
CLIA Number 21D0220436
LAB Type Physician Office
Facility Name MARYLAND PRIMARY CARE PHYSICIAN LLC
Street 125 SHOREWAY DRIVE SUITE 120
City QUEENSTOWN
State MD
ZIP 21658
Phone 410 827-4001
Certificate Type Certificate for Provider-Performed Microscopy Procedures (PPMP)
Certificate Type Description This certificate is issued to a laboratory in which a physician, midlevel practitioner or dentist performs no tests other than the microscopy procedures. This certificate permits the laboratory to also perform waived tests.
Certificate Effective Date 2/7/2024
Certificate Expiration Date 2/6/2026
Facility Type Physician Office
Lab Director TIMOTHY M. KLEPPER

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This page was last updated on: 9/29/2025