21D1015475 CLIA NUMBER - LAUREL PEDIATRIC TEENS & MED CTR

Laboratory Demographics

  • CLIA Code: 21D1015475
  • Facility Name: LAUREL PEDIATRIC TEENS & MED CTR
  • Facility Address: 2014 S TOLLGATE RD SUITE 200-201
    BEL AIR, MD
    ZIP 21015
  • Facility Phone: 410 569-9533
  • Facility Type: Physician Office
  • Facility Type: Waiver
  • Lab Director: GENEROSA C. LAZOR MD
  • NPI Number: 1093724163
  • Taxonomy: 261QP2300X - Clinic/Center

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CLIA Record

Field Name Field Value
CLIA Number 21D1015475
LAB Type Physician Office
Facility Name LAUREL PEDIATRIC TEENS & MED CTR
Street 2014 S TOLLGATE RD SUITE 200-201
City BEL AIR
State MD
ZIP 21015
Phone 410 569-9533
Certificate Type Certificate of Waiver
Certificate Type Description This certificate is issued to a laboratory to perform only waived tests.
Certificate Effective Date 10/17/2024
Certificate Expiration Date 10/16/2026
Facility Type Physician Office
Lab Director GENEROSA C. LAZOR MD

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