21D1037930 CLIA NUMBER - DAVID W KOSSOFF MD PA DBA OPTIMAL DIGESTIVE CARE

Laboratory Demographics

  • CLIA Code: 21D1037930
  • Facility Name: DAVID W KOSSOFF MD PA DBA OPTIMAL DIGESTIVE CARE
  • Facility Address: 110 THOMAS JOHNSON DR STE 335
    FREDERICK, MD
    ZIP 21702
  • Facility Phone: 301 624-5566
  • Facility Type: Physician Office
  • Facility Type: Waiver
  • Lab Director: DAVID W. KOSSOFF
  • NPI Number: 1629152582
  • Taxonomy: 174400000X - Specialist

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CLIA Record

Field Name Field Value
CLIA Number 21D1037930
LAB Type Physician Office
Facility Name DAVID W KOSSOFF MD PA DBA OPTIMAL DIGESTIVE CARE
Street 110 THOMAS JOHNSON DR STE 335
City FREDERICK
State MD
ZIP 21702
Phone 301 624-5566
Certificate Type Certificate of Waiver
Certificate Type Description This certificate is issued to a laboratory to perform only waived tests.
Certificate Effective Date 3/8/2025
Certificate Expiration Date 3/7/2027
Facility Type Physician Office
Lab Director DAVID W. KOSSOFF

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