21D0221294 CLIA NUMBER - PRINCESS ANNE FAMILY PRACTICE

Laboratory Demographics

  • CLIA Code: 21D0221294
  • Facility Name: PRINCESS ANNE FAMILY PRACTICE
  • Facility Address: 30434 MT VERNON RD
    PRINCESS ANNE, MD
    ZIP 21853
  • Facility Phone: (410) 651-0350
  • Facility Type: Physician Office
  • Facility Type: Microscopy
  • Lab Director: CHARLES B. HOFMANN
  • NPI Number: 1831183169
  • Taxonomy: 207Q00000X - Family Medicine

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CLIA Record

Field Name Field Value
CLIA Number 21D0221294
LAB Type Physician Office
Facility Name PRINCESS ANNE FAMILY PRACTICE
Street 30434 MT VERNON RD
City PRINCESS ANNE
State MD
ZIP 21853
Phone 4106510350
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 10/3/2024
Certificate Expiration Date 10/2/2026
Facility Type Physician Office
Lab Director CHARLES B. HOFMANN

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This page was last updated on: 6/29/2026