21D0894223 CLIA NUMBER - TIDEWAY DERMATOLOGY

Laboratory Demographics

  • CLIA Code: 21D0894223
  • Facility Name: TIDEWAY DERMATOLOGY
  • Facility Address: 930 REVOLUTION ST
    HAVRE DE GRACE, MD
    ZIP 21078
  • Facility Phone: 410 939-0961
  • Facility Type: Physician Office
  • Facility Type: Certificate of Compliance
  • Lab Director: DAVID F. JAFFE
  • NPI Number: 1619054525
  • Taxonomy: 174400000X - Specialist

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CLIA Record

Field Name Field Value
CLIA Number 21D0894223
LAB Type Physician Office
Facility Name TIDEWAY DERMATOLOGY
Street 930 REVOLUTION ST
City HAVRE DE GRACE
State MD
ZIP 21078
Phone 410 939-0961
Certificate Type Certificate of Compliance
Certificate Type Description This certificate is issued to a laboratory after an inspection that finds the laboratory to be in compliance with all applicable CLIA requirements.
Certificate Effective Date 10/28/2023
Certificate Expiration Date 10/27/2025
Facility Type Physician Office
Lab Director DAVID F. JAFFE

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