21D1013259 CLIA NUMBER - PAUL AMBUSH MD PA

Laboratory Demographics

  • CLIA Code: 21D1013259
  • Facility Name: PAUL AMBUSH MD PA
  • Facility Address: 6100 DAYLONG LANE #210
    CLARKSVILLE, MD
    ZIP 21029
  • Facility Phone: 410 531-7566
  • Facility Type: Physician Office
  • Facility Type: Waiver
  • Lab Director: PAUL F. AMBUSH
  • NPI Number: 1730105461
  • Taxonomy: 208000000X - Pediatrics

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CLIA Record

Field Name Field Value
CLIA Number 21D1013259
LAB Type Physician Office
Facility Name PAUL AMBUSH MD PA
Street 6100 DAYLONG LANE #210
City CLARKSVILLE
State MD
ZIP 21029
Phone 410 531-7566
Certificate Type Certificate of Waiver
Certificate Type Description This certificate is issued to a laboratory to perform only waived tests.
Certificate Effective Date 6/5/2025
Certificate Expiration Date 6/4/2027
Facility Type Physician Office
Lab Director PAUL F. AMBUSH

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