21D0678270 CLIA NUMBER - SUSQUEHANNA OBGYN LLC

Laboratory Demographics

  • CLIA Code: 21D0678270
  • Facility Name: SUSQUEHANNA OBGYN LLC
  • Facility Address: 308 N UNION AVE
    HAVRE DE GRACE, MD
    ZIP 21078
  • Facility Phone: 410 939-3121
  • Facility Type: Physician Office
  • Facility Type: Microscopy
  • Lab Director: KATHLEEN GOTZMANN
  • NPI Number: 1215740154
  • Taxonomy: 207V00000X - Obstetrics & Gynecology

Map and Directions

Get Directions

CLIA Record

Field Name Field Value
CLIA Number 21D0678270
LAB Type Physician Office
Facility Name SUSQUEHANNA OBGYN LLC
Street 308 N UNION AVE
City HAVRE DE GRACE
State MD
ZIP 21078
Phone 410 939-3121
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 9/1/2024
Certificate Expiration Date 8/31/2026
Facility Type Physician Office
Lab Director KATHLEEN GOTZMANN

Download Record

Download this CLIA record record in Text format: Export

Download this CLIA record record in Excel (CSV) format: Export

Download this CLIA record record in XML format: Export

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