21D1011189 CLIA NUMBER - MID-MARYLAND UROLOGIC SERVICES

Laboratory Demographics

  • CLIA Code: 21D1011189
  • Facility Name: MID-MARYLAND UROLOGIC SERVICES
  • Facility Address: 97 THOMAS JOHNSON DRIVE STE 102
    FREDERICK, MD
    ZIP 21701
  • Facility Phone: 301 694-0414
  • Facility Type: Physician Office
  • Facility Type: Microscopy
  • Lab Director: BERT E. WILLIAMS MD
  • NPI Number: 1871781435
  • Taxonomy: 208800000X - Urology

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CLIA Record

Field Name Field Value
CLIA Number 21D1011189
LAB Type Physician Office
Facility Name MID-MARYLAND UROLOGIC SERVICES
Street 97 THOMAS JOHNSON DRIVE STE 102
City FREDERICK
State MD
ZIP 21701
Phone 301 694-0414
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 4/3/2025
Certificate Expiration Date 4/2/2027
Facility Type Physician Office
Lab Director BERT E. WILLIAMS MD

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