21D1011194 CLIA NUMBER - AVIATION BLVD DIALYSIS

Laboratory Demographics

  • CLIA Code: 21D1011194
  • Facility Name: AVIATION BLVD DIALYSIS
  • Facility Address: 6934 AVIATION BLVD STE K
    GLEN BURNIE, MD
    ZIP 21061
  • Facility Phone: 410 553-6951
  • Facility Type: End Stage Renal Disease Dialysis Facility
  • Facility Type: Waiver
  • Lab Director: DR. TEDINE RANICH
  • NPI Number: 1255623534
  • Taxonomy: 261QE0700X - Clinic/Center

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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
Certificate Type Certificate of Waiver
Certificate Type Description This certificate is issued to a laboratory to perform only waived tests.
Certificate Effective Date 4/3/2025
Certificate Expiration Date 4/2/2027
Facility Type End Stage Renal Disease Dialysis Facility
Lab Director DR. TEDINE RANICH

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