21D0933177 CLIA NUMBER - FREDERICK PRIMARY CARE

Laboratory Demographics

  • CLIA Code: 21D0933177
  • Facility Name: FREDERICK PRIMARY CARE
  • Facility Address: 610 SOLAREX COURT
    FREDERICK, MD
    ZIP 21703
  • Facility Phone: 301 682-5500
  • Facility Type: Physician Office
  • Facility Type: Microscopy
  • Lab Director: DR. DALE R. HEITZIG
  • NPI Number: 1689658890
  • Taxonomy: 207Q00000X - Family Medicine

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CLIA Record

Field Name Field Value
CLIA Number 21D0933177
LAB Type Physician Office
Facility Name FREDERICK PRIMARY CARE
Street 610 SOLAREX COURT
City FREDERICK
State MD
ZIP 21703
Phone 301 682-5500
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 4/1/2025
Certificate Expiration Date 3/31/2027
Facility Type Physician Office
Lab Director DR. DALE R. HEITZIG

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