21D1004200 CLIA NUMBER - COPPIN STATE UNIVERSITY COMM HEALTH CENTER

Laboratory Demographics

  • CLIA Code: 21D1004200
  • Facility Name: COPPIN STATE UNIVERSITY COMM HEALTH CENTER
  • Facility Address: 2601 WEST NORTH AVENUE, STE 131
    BALTIMORE, MD
    ZIP 21216
  • Facility Phone: 410 951-4188
  • Facility Type: Community Clinic
  • Facility Type: Microscopy
  • Lab Director: SHAVON DARDEN
  • NPI Number: 1427244706
  • Taxonomy: 261QP2300X - Clinic/Center

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CLIA Record

Field Name Field Value
CLIA Number 21D1004200
LAB Type Community Clinic
Facility Name COPPIN STATE UNIVERSITY COMM HEALTH CENTER
Street 2601 WEST NORTH AVENUE, STE 131
City BALTIMORE
State MD
ZIP 21216
Phone 410 951-4188
Certificate Type Certificate for Provider-Performed Microscopy Procedures (PPMP)
Certificate Type Description This certificate is issued to a laboratory in which a physician, midlevel practitioner or dentist performs no tests other than the microscopy procedures. This certificate permits the laboratory to also perform waived tests.
Certificate Effective Date 4/20/2024
Certificate Expiration Date 4/19/2026
Facility Type Community Clinic
Lab Director SHAVON DARDEN

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