21D0910525 CLIA NUMBER - PREMIERE CHILDRENS PHYSICIANS, PA

Laboratory Demographics

  • CLIA Code: 21D0910525
  • Facility Name: PREMIERE CHILDRENS PHYSICIANS, PA
  • Facility Address: 703 N BRIDGE STREET NORTHSIDE PLAZA STE 104
    ELKTON, MD
    ZIP 21921
  • Facility Phone: 410 398-5930
  • Facility Type: Physician Office
  • Facility Type: Waiver
  • Lab Director: LESTER B. HORRELL MD
  • NPI Number: 1235461039
  • Taxonomy: 174400000X - Specialist

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CLIA Record

Field Name Field Value
CLIA Number 21D0910525
LAB Type Physician Office
Facility Name PREMIERE CHILDRENS PHYSICIANS, PA
Street 703 N BRIDGE STREET NORTHSIDE PLAZA STE 104
City ELKTON
State MD
ZIP 21921
Phone 410 398-5930
Certificate Type Certificate of Waiver
Certificate Type Description This certificate is issued to a laboratory to perform only waived tests.
Certificate Effective Date 1/1/2025
Certificate Expiration Date 12/31/2026
Facility Type Physician Office
Lab Director LESTER B. HORRELL MD

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