21D1015671 CLIA NUMBER - ATLANTIC GENERAL INTERNAL MEDICINE

Laboratory Demographics

  • CLIA Code: 21D1015671
  • Facility Name: ATLANTIC GENERAL INTERNAL MEDICINE
  • Facility Address: 10324 OLD OCEAN CITY BLVD
    BERLIN, MD
    ZIP 21811
  • Facility Phone: 410 629-0041
  • Facility Type: Physician Office
  • Facility Type: Waiver
  • Lab Director: EDWIN T. CASTANEDA MD
  • NPI Number: 1518199223
  • Taxonomy: 208D00000X - General Practice

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CLIA Record

Field Name Field Value
CLIA Number 21D1015671
LAB Type Physician Office
Facility Name ATLANTIC GENERAL INTERNAL MEDICINE
Street 10324 OLD OCEAN CITY BLVD
City BERLIN
State MD
ZIP 21811
Phone 410 629-0041
Certificate Type Certificate of Waiver
Certificate Type Description This certificate is issued to a laboratory to perform only waived tests.
Certificate Effective Date 8/12/2025
Certificate Expiration Date 8/11/2027
Facility Type Physician Office
Lab Director EDWIN T. CASTANEDA MD

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