21D0875962 CLIA NUMBER - KENNETH M GREENE MD

Laboratory Demographics

  • CLIA Code: 21D0875962
  • Facility Name: KENNETH M GREENE MD
  • Facility Address: 6701 NORTH CHARLES STREET SUITE 4104
    BALTIMORE, MD
    ZIP 21204
  • Facility Phone: 410 821-2800
  • Facility Type: Health Main. Organization
  • Facility Type: Waiver
  • Lab Director: KENNETH M. GREENE MD
  • NPI Number: 1497869903
  • Taxonomy: 207R00000X - Internal Medicine

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CLIA Record

Field Name Field Value
CLIA Number 21D0875962
LAB Type Health Main. Organization
Facility Name KENNETH M GREENE MD
Street 6701 NORTH CHARLES STREET SUITE 4104
City BALTIMORE
State MD
ZIP 21204
Phone 410 821-2800
Certificate Type Certificate of Waiver
Certificate Type Description This certificate is issued to a laboratory to perform only waived tests.
Certificate Effective Date 9/3/2023
Certificate Expiration Date 9/2/2025
Facility Type Health Main. Organization
Lab Director KENNETH M. GREENE MD

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This page was last updated on: 6/4/2025