21D0861497 CLIA NUMBER - BENJAMIN LARRY JENKINS JR MD

Laboratory Demographics

  • CLIA Code: 21D0861497
  • Facility Name: BENJAMIN LARRY JENKINS JR MD
  • Facility Address: 111 LAGRANGE AVENUE
    LA PLATA, MD
    ZIP 20646
  • Facility Phone: 301 934-2887
  • Facility Type: Physician Office
  • Facility Type: Microscopy
  • Lab Director: DR. B LARRY JENKINS JR
  • NPI Number: 1437291713
  • Taxonomy: 207R00000X - Internal Medicine

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CLIA Record

Field Name Field Value
CLIA Number 21D0861497
LAB Type Physician Office
Facility Name BENJAMIN LARRY JENKINS JR MD
Street 111 LAGRANGE AVENUE
City LA PLATA
State MD
ZIP 20646
Phone 301 934-2887
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 DR. B LARRY JENKINS JR

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