21D0971651 CLIA NUMBER - BAYSIDE FAMILY PRACTICE LLC

Laboratory Demographics

  • CLIA Code: 21D0971651
  • Facility Name: BAYSIDE FAMILY PRACTICE LLC
  • Facility Address: 538 CYNWOOD DRIVE STE 2
    EASTON, MD
    ZIP 21601
  • Facility Phone: 410 763-8999
  • Facility Type: Physician Office
  • Facility Type: Microscopy
  • Lab Director: JENNIFER A. HOLLYWOOD MD
  • NPI Number: 1700068160
  • Taxonomy: 207Q00000X - Family Medicine

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CLIA Record

Field Name Field Value
CLIA Number 21D0971651
LAB Type Physician Office
Facility Name BAYSIDE FAMILY PRACTICE LLC
Street 538 CYNWOOD DRIVE STE 2
City EASTON
State MD
ZIP 21601
Phone 410 763-8999
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 3/17/2024
Certificate Expiration Date 3/16/2026
Facility Type Physician Office
Lab Director JENNIFER A. HOLLYWOOD MD

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