21D0976702 CLIA NUMBER - EHMG OF MD RIDERWOOD VILLAGE MEDICAL CTR

Laboratory Demographics

CLIA Number: 21D0976702

Facility Name: EHMG OF MD RIDERWOOD VILLAGE MEDICAL CTR

Facility Address:
3110 GRACEFIELD ROAD
SILVER SPRING, MD
ZIP 20904
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Facility Phone Number: 301 572-8340

Facility Type: Physician Office

Certificate Type: Microscopy

NPI Number: 1205856549

Taxonomy: 207RG0300X - Internal Medicine
An internist who has special knowledge of the aging process and special skills in the diagnostic, therapeutic, preventive and rehabilitative aspects of illness in the elderly. This specialist cares for geriatric patients in the patient's home, the office, long-term care settings such as nursing homes and the hospital.

CLIA Record

Field Name	Field Value
CLIA Number	21D0976702
LAB Type	Physician Office
Facility Name	EHMG OF MD RIDERWOOD VILLAGE MEDICAL CTR
Street	3110 GRACEFIELD ROAD
City	SILVER SPRING
State	MD
ZIP	20904
Phone	301 572-8340
CertificateType	3
CertificateEffectiveDate	4/27/2023
CertificateExpirationDate	4/26/2025
FacilityType	PPMP

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This page was last updated on: 4/23/2024