21D1000784 CLIA NUMBER - MIDDLEBROOK DIALYSIS

Laboratory Demographics

CLIA Number: 21D1000784

Facility Name: MIDDLEBROOK DIALYSIS

Facility Address:
12401 MIDDLEBROOK RD SSTE 160
GERMANTOWN, MD
ZIP 20874
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Facility Phone Number: 301 540-6020

Facility Type: End Stage Renal Disease Dialysis Facility

Certificate Type: Waiver

NPI Number: 1437437159

Taxonomy: 261QE0700X - Clinic/Center

CLIA Record

Field Name	Field Value
CLIA Number	21D1000784
LAB Type	End Stage Renal Disease Dialysis Facility
Facility Name	MIDDLEBROOK DIALYSIS
Street	12401 MIDDLEBROOK RD SSTE 160
City	GERMANTOWN
State	MD
ZIP	20874
Phone	301 540-6020
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