21D0960745 CLIA NUMBER - MARSHA Y BLAKESLEE DO LLC

Laboratory Demographics

  • CLIA Code: 21D0960745
  • Facility Name: MARSHA Y BLAKESLEE DO LLC
  • Facility Address: 479 JUMPERS HOLE ROAD SUITE 304A
    SEVERNA PARK, MD
    ZIP 21146
  • Facility Phone: 410 544-0053
  • Facility Type: Physician Office
  • Facility Type: Microscopy
  • Lab Director: MARSHA Y. BLAKESLEE MD
  • NPI Number: 1902925639
  • Taxonomy: 207R00000X - Internal Medicine

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CLIA Record

Field Name Field Value
CLIA Number 21D0960745
LAB Type Physician Office
Facility Name MARSHA Y BLAKESLEE DO LLC
Street 479 JUMPERS HOLE ROAD SUITE 304A
City SEVERNA PARK
State MD
ZIP 21146
Phone 410 544-0053
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 5/19/2025
Certificate Expiration Date 5/18/2027
Facility Type Physician Office
Lab Director MARSHA Y. BLAKESLEE MD

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