21D0927258 CLIA NUMBER - ALICE TANNER MD PC

Laboratory Demographics

  • CLIA Code: 21D0927258
  • Facility Name: ALICE TANNER MD PC
  • Facility Address: 1404 SOUTH CRAIN HIGHWAY SUITE 109
    GLEN BURNIE, MD
    ZIP 21061
  • Facility Phone: 410 768-2231
  • Facility Type: Physician Office
  • Facility Type: Waiver
  • Lab Director: ALICE TANNER
  • NPI Number: 1184646309
  • Taxonomy: 208000000X - Pediatrics

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CLIA Record

Field Name Field Value
CLIA Number 21D0927258
LAB Type Physician Office
Facility Name ALICE TANNER MD PC
Street 1404 SOUTH CRAIN HIGHWAY SUITE 109
City GLEN BURNIE
State MD
ZIP 21061
Phone 410 768-2231
Certificate Type Certificate of Waiver
Certificate Type Description This certificate is issued to a laboratory to perform only waived tests.
Certificate Effective Date 4/14/2025
Certificate Expiration Date 4/13/2027
Facility Type Physician Office
Lab Director ALICE TANNER

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