21D0887328 CLIA NUMBER - EAST BALTIMORE MEDICAL CTR

Laboratory Demographics

CLIA Number: 21D0887328

Facility Name: EAST BALTIMORE MEDICAL CTR

Facility Address:
1000 EAST EAGER STREET
BALTIMORE, MD
ZIP 21202
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Facility Phone Number: 410 732-8800

Facility Type: Physician Office

Certificate Type: Microscopy

NPI Number: 1194796615

Taxonomy: 101YA0400X - Counselor

CLIA Record

Field Name	Field Value
CLIA Number	21D0887328
LAB Type	Physician Office
Facility Name	EAST BALTIMORE MEDICAL CTR
Street	1000 EAST EAGER STREET
City	BALTIMORE
State	MD
ZIP	21202
Phone	410 732-8800
CertificateType	3
CertificateEffectiveDate	6/9/2022
CertificateExpirationDate	6/8/2024
FacilityType	PPMP

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This page was last updated on: 4/23/2024