21D0976506 CLIA NUMBER - SUSAN J HENLEY MD

Laboratory Demographics

  • CLIA Code: 21D0976506
  • Facility Name: SUSAN J HENLEY MD
  • Facility Address: 1501 SULGRAVE AVENUE #306
    BALTIMORE, MD
    ZIP 21209
  • Facility Phone: 410 433-8801
  • Facility Type: Physician Office
  • Facility Type: Microscopy
  • Lab Director: SUSAN J. HENLEY
  • NPI Number: 1902867781
  • Taxonomy: 207Q00000X - Family Medicine

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CLIA Record

Field Name Field Value
CLIA Number 21D0976506
LAB Type Physician Office
Facility Name SUSAN J HENLEY MD
Street 1501 SULGRAVE AVENUE #306
City BALTIMORE
State MD
ZIP 21209
Phone 410 433-8801
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 4/11/2025
Certificate Expiration Date 4/10/2027
Facility Type Physician Office
Lab Director SUSAN J. HENLEY

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