21D1028729 CLIA NUMBER - THEODORE WELLS-GREEN MD

Laboratory Demographics

  • CLIA Code: 21D1028729
  • Facility Name: THEODORE WELLS-GREEN MD
  • Facility Address: 9886-A MAIN STREET
    DAMASCUS, MD
    ZIP 20872
  • Facility Phone: 301 368-3660
  • Facility Type: Physician Office
  • Facility Type: Waiver
  • Lab Director: THEODORE F. WELLS-GREEN
  • NPI Number: 1730131202
  • Taxonomy: 208000000X - Pediatrics

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CLIA Record

Field Name Field Value
CLIA Number 21D1028729
LAB Type Physician Office
Facility Name THEODORE WELLS-GREEN MD
Street 9886-A MAIN STREET
City DAMASCUS
State MD
ZIP 20872
Phone 301 368-3660
Certificate Type Certificate of Waiver
Certificate Type Description This certificate is issued to a laboratory to perform only waived tests.
Certificate Effective Date 8/2/2024
Certificate Expiration Date 8/1/2026
Facility Type Physician Office
Lab Director THEODORE F. WELLS-GREEN

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