21D0996779 CLIA NUMBER - ACTIVE DAY MD INC DBA ACTIVE DAY OF RANDALLSTOWN

Laboratory Demographics

  • CLIA Code: 21D0996779
  • Facility Name: ACTIVE DAY MD INC DBA ACTIVE DAY OF RANDALLSTOWN
  • Facility Address: 9637 LIBERTY ROAD STE K
    RANDALLSTOWN, MD
    ZIP 21133
  • Facility Phone: 410 922-8600
  • Facility Type: Other - ADULT DAY MEDICAL CENTER
  • Facility Type: Waiver
  • Lab Director: DR. BRIAN C. WALLACE
  • NPI Number: 1720122674
  • Taxonomy: 261QA0600X - Clinic/Center

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CLIA Record

Field Name Field Value
CLIA Number 21D0996779
LAB Type Other - ADULT DAY MEDICAL CENTER
Facility Name ACTIVE DAY MD INC DBA ACTIVE DAY OF RANDALLSTOWN
Street 9637 LIBERTY ROAD STE K
City RANDALLSTOWN
State MD
ZIP 21133
Phone 410 922-8600
Certificate Type Certificate of Waiver
Certificate Type Description This certificate is issued to a laboratory to perform only waived tests.
Certificate Effective Date 2/27/2024
Certificate Expiration Date 2/26/2026
Facility Type Other - ADULT DAY MEDICAL CENTER
Lab Director DR. BRIAN C. WALLACE

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