21D1021899 CLIA NUMBER - SUMMIT MEDICAL GROUP

Laboratory Demographics

  • CLIA Code: 21D1021899
  • Facility Name: SUMMIT MEDICAL GROUP
  • Facility Address: 6310 STEVENS FOREST RD STE 200
    COLUMBIA, MD
    ZIP 21046
  • Facility Phone: 410 740-9001
  • Facility Type: Physician Office
  • Facility Type: Waiver
  • Lab Director: NJIDEKA UDOCHI MD
  • NPI Number: 1952970816
  • Taxonomy: 261QM1300X - Clinic/Center

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CLIA Record

Field Name Field Value
CLIA Number 21D1021899
LAB Type Physician Office
Facility Name SUMMIT MEDICAL GROUP
Street 6310 STEVENS FOREST RD STE 200
City COLUMBIA
State MD
ZIP 21046
Phone 410 740-9001
Certificate Type Certificate of Waiver
Certificate Type Description This certificate is issued to a laboratory to perform only waived tests.
Certificate Effective Date 1/10/2025
Certificate Expiration Date 1/9/2027
Facility Type Physician Office
Lab Director NJIDEKA UDOCHI MD

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