21D0909947 CLIA NUMBER - MID ATLANTIC SKIN SURGERY MOHS LAB

Laboratory Demographics

  • CLIA Code: 21D0909947
  • Facility Name: MID ATLANTIC SKIN SURGERY MOHS LAB
  • Facility Address: 26840 PT LOOKOUT RD, SHANTI MED CTR, ROUTE 5
    LEONARDTOWN, MD
    ZIP 20650
  • Facility Phone: 301 396-3401
  • Facility Type: Physician Office
  • Facility Type: Certificate of Compliance
  • Lab Director: GEORGE K. VERGHESE
  • NPI Number: 1790713782
  • Taxonomy: 207N00000X - Dermatology

Map and Directions

Get Directions

CLIA Record

Field Name Field Value
CLIA Number 21D0909947
LAB Type Physician Office
Facility Name MID ATLANTIC SKIN SURGERY MOHS LAB
Street 26840 PT LOOKOUT RD, SHANTI MED CTR, ROUTE 5
City LEONARDTOWN
State MD
ZIP 20650
Phone 301 396-3401
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 2/27/2024
Certificate Expiration Date 2/26/2026
Facility Type Physician Office
Lab Director GEORGE K. VERGHESE

Download Record

Download this CLIA record record in Text format: Export

Download this CLIA record record in Excel (CSV) format: Export

Download this CLIA record record in XML format: Export

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