21D0692067 CLIA NUMBER - BRADDOCK MEDICAL GROUP

Laboratory Demographics

  • CLIA Code: 21D0692067
  • Facility Name: BRADDOCK MEDICAL GROUP
  • Facility Address: 912 SETON DRIVE
    CUMBERLAND, MD
    ZIP 21502
  • Facility Phone: 301 722-3111
  • Facility Type: Physician Office
  • Facility Type: Microscopy
  • Lab Director: PAUL T. LIVENGOOD
  • NPI Number: 1104901313
  • Taxonomy: 291U00000X - Clinical Medical Laboratory

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CLIA Record

Field Name Field Value
CLIA Number 21D0692067
LAB Type Physician Office
Facility Name BRADDOCK MEDICAL GROUP
Street 912 SETON DRIVE
City CUMBERLAND
State MD
ZIP 21502
Phone 301 722-3111
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 2/6/2025
Certificate Expiration Date 2/5/2027
Facility Type Physician Office
Lab Director PAUL T. LIVENGOOD

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