21D1017716 CLIA NUMBER - GERMANTOWN DIALYSIS

Laboratory Demographics

CLIA Number: 21D1017716

Facility Name: GERMANTOWN DIALYSIS

Facility Address:
20111 CENTURY BLVD STE B&C
GERMANTOWN, MD
ZIP 20874
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Facility Phone Number: 301 540-4601

Facility Type: End Stage Renal Disease Dialysis Facility

Certificate Type: Waiver

NPI Number: 1952361370

Taxonomy: 261QE0700X - Clinic/Center

CLIA Record

Field Name	Field Value
CLIA Number	21D1017716
LAB Type	End Stage Renal Disease Dialysis Facility
Facility Name	GERMANTOWN DIALYSIS
Street	20111 CENTURY BLVD STE B&C
City	GERMANTOWN
State	MD
ZIP	20874
Phone	301 540-4601
CertificateType	4
CertificateEffectiveDate	10/2/2023
CertificateExpirationDate	10/1/2025
FacilityType	Waiver

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