21D1041452 CLIA NUMBER - DCA OF WEST BALTIMORE, LLC DBA US RENAL CARE WEST BALTIMORE DIALYSIS

Laboratory Demographics

  • CLIA Code: 21D1041452
  • Facility Name: DCA OF WEST BALTIMORE, LLC DBA US RENAL CARE WEST BALTIMORE DIALYSIS
  • Facility Address: 22 S ATHOL AVENUE
    BALTIMORE, MD
    ZIP 21229
  • Facility Phone: 410 947-3227
  • Facility Type: End Stage Renal Disease Dialysis Facility
  • Facility Type: Waiver
  • Lab Director: ROBERT FULD MD
  • NPI Number: 1881657203
  • Taxonomy: 261QE0700X - Clinic/Center

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CLIA Record

Field Name Field Value
CLIA Number 21D1041452
LAB Type End Stage Renal Disease Dialysis Facility
Facility Name DCA OF WEST BALTIMORE, LLC DBA US RENAL CARE WEST BALTIMORE DIALYSIS
Street 22 S ATHOL AVENUE
City BALTIMORE
State MD
ZIP 21229
Phone 410 947-3227
Certificate Type Certificate of Waiver
Certificate Type Description This certificate is issued to a laboratory to perform only waived tests.
Certificate Effective Date 6/3/2023
Certificate Expiration Date 6/2/2025
Facility Type End Stage Renal Disease Dialysis Facility
Lab Director ROBERT FULD MD

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This page was last updated on: 3/20/2025