21D0691530 CLIA NUMBER - FREDERICK REGIONAL MED CTR POTOMAC PHYSICIANS

Laboratory Demographics

  • CLIA Code: 21D0691530
  • Facility Name: FREDERICK REGIONAL MED CTR POTOMAC PHYSICIANS
  • Facility Address: 110 BAUGHMAN'S LANE STE 270 ATTN TYRONE JONES
    FREDERICK, MD
    ZIP 21702
  • Facility Phone: 410 998-9100
  • Facility Type: Health Main. Organization
  • Facility Type: Microscopy
  • Lab Director: MATTHEW POFFENROTH
  • NPI Number: 1265592166
  • Taxonomy: 310400000X - Assisted Living Facility

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CLIA Record

Field Name Field Value
CLIA Number 21D0691530
LAB Type Health Main. Organization
Facility Name FREDERICK REGIONAL MED CTR POTOMAC PHYSICIANS
Street 110 BAUGHMAN'S LANE STE 270 ATTN TYRONE JONES
City FREDERICK
State MD
ZIP 21702
Phone 410 998-9100
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 7/31/2024
Certificate Expiration Date 7/30/2026
Facility Type Health Main. Organization
Lab Director MATTHEW POFFENROTH

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