21D0686463 CLIA NUMBER - POOLESVILLE FAMILY PRACTICE

Laboratory Demographics

  • CLIA Code: 21D0686463
  • Facility Name: POOLESVILLE FAMILY PRACTICE
  • Facility Address: 19710 FISHER AVENUE STE J
    POOLESVILLE, MD
    ZIP 20837
  • Facility Phone: 301 972-7600
  • Facility Type: Physician Office
  • Facility Type: Waiver
  • Lab Director: AMAR DUGGIRALA DO
  • NPI Number: 1033142393
  • Taxonomy: 207Q00000X - Family Medicine

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CLIA Record

Field Name Field Value
CLIA Number 21D0686463
LAB Type Physician Office
Facility Name POOLESVILLE FAMILY PRACTICE
Street 19710 FISHER AVENUE STE J
City POOLESVILLE
State MD
ZIP 20837
Phone 301 972-7600
Certificate Type Certificate of Waiver
Certificate Type Description This certificate is issued to a laboratory to perform only waived tests.
Certificate Effective Date 7/18/2024
Certificate Expiration Date 7/17/2026
Facility Type Physician Office
Lab Director AMAR DUGGIRALA DO

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