21D1011194 CLIA NUMBER - AVIATION BLVD DIALYSIS

Laboratory Demographics

CLIA Number: 21D1011194

Facility Name: AVIATION BLVD DIALYSIS

Facility Address:
6934 AVIATION BLVD STE K
GLEN BURNIE, MD
ZIP 21061
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Facility Phone Number: 410 553-6951

Facility Type: End Stage Renal Disease Dialysis Facility

Certificate Type: Waiver

NPI Number: 1255623534

Taxonomy: 261QE0700X - Clinic/Center

CLIA Record

Field Name	Field Value
CLIA Number	21D1011194
LAB Type	End Stage Renal Disease Dialysis Facility
Facility Name	AVIATION BLVD DIALYSIS
Street	6934 AVIATION BLVD STE K
City	GLEN BURNIE
State	MD
ZIP	21061
Phone	410 553-6951
CertificateType	4
CertificateEffectiveDate	4/3/2023
CertificateExpirationDate	4/2/2025
FacilityType	Waiver

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