21D0984098 CLIA NUMBER - BALTIMORE AMBULATORY CTR FOR ENDOSCOPY

Laboratory Demographics

  • CLIA Code: 21D0984098
  • Facility Name: BALTIMORE AMBULATORY CTR FOR ENDOSCOPY
  • Facility Address: 19 FONTANA LANE STE 104
    BALTIMORE, MD
    ZIP 21237
  • Facility Phone: 410 574-7776
  • Facility Type: Ambulatory Surgery Center
  • Facility Type: Waiver
  • Lab Director: JAHANGHIR KHAN
  • NPI Number: 1346270428
  • Taxonomy: 261QA1903X - Clinic/Center

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CLIA Record

Field Name Field Value
CLIA Number 21D0984098
LAB Type Ambulatory Surgery Center
Facility Name BALTIMORE AMBULATORY CTR FOR ENDOSCOPY
Street 19 FONTANA LANE STE 104
City BALTIMORE
State MD
ZIP 21237
Phone 410 574-7776
Certificate Type Certificate of Waiver
Certificate Type Description This certificate is issued to a laboratory to perform only waived tests.
Certificate Effective Date 3/13/2025
Certificate Expiration Date 3/12/2027
Facility Type Ambulatory Surgery Center
Lab Director JAHANGHIR KHAN

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