21D1000781 CLIA NUMBER - GHOUSIA SULTANA

Laboratory Demographics

CLIA Number: 21D1000781

Facility Name: GHOUSIA SULTANA

Facility Address:
12107 HERITAGE PARK CIRCLE
SILVER SPRING, MD
ZIP 20906
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Facility Phone Number: 301 949-7000

Facility Type: Physician Office

Certificate Type: Waiver

NPI Number: 1346294279

Taxonomy: 207RH0000X - Internal Medicine
An internist with additional training who specializes in diseases of the blood, spleen and lymph. This specialist treats conditions such as anemia, clotting disorders, sickle cell disease, hemophilia, leukemia and lymphoma.

CLIA Record

Field Name	Field Value
CLIA Number	21D1000781
LAB Type	Physician Office
Facility Name	GHOUSIA SULTANA
Street	12107 HERITAGE PARK CIRCLE
City	SILVER SPRING
State	MD
ZIP	20906
Phone	301 949-7000
CertificateType	4
CertificateEffectiveDate	6/24/2022
CertificateExpirationDate	6/23/2024
FacilityType	Waiver

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