21D0920587 CLIA NUMBER - SETON MEDICAL GROUP ELLICOTT CITY

Laboratory Demographics

  • CLIA Code: 21D0920587
  • Facility Name: SETON MEDICAL GROUP ELLICOTT CITY
  • Facility Address: 2850 NORTH RIDGE ROAD SUITE 103
    ELLICOTT CITY, MD
    ZIP 21043
  • Facility Phone: 410 465-8119
  • Facility Type: Physician Office
  • Facility Type: Microscopy
  • Lab Director: KATHLEEN YORK-JORDAN MD
  • NPI Number: 1518787142
  • Taxonomy: 207Q00000X - Family Medicine

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CLIA Record

Field Name Field Value
CLIA Number 21D0920587
LAB Type Physician Office
Facility Name SETON MEDICAL GROUP ELLICOTT CITY
Street 2850 NORTH RIDGE ROAD SUITE 103
City ELLICOTT CITY
State MD
ZIP 21043
Phone 410 465-8119
Certificate Type Certificate for Provider-Performed Microscopy Procedures (PPMP)
Certificate Type Description This certificate is issued to a laboratory in which a physician, midlevel practitioner or dentist performs no tests other than the microscopy procedures. This certificate permits the laboratory to also perform waived tests.
Certificate Effective Date 10/4/2024
Certificate Expiration Date 10/3/2026
Facility Type Physician Office
Lab Director KATHLEEN YORK-JORDAN MD

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