21D1048999 CLIA NUMBER - MID-ATLANTIC SURGERY PAVILION

Laboratory Demographics

CLIA Number: 21D1048999

Facility Name: MID-ATLANTIC SURGERY PAVILION

Facility Address:
1111 BEARDS HILL ROAD STE 700
ABERDEEN, MD
ZIP 21001
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Facility Phone Number: 410 935-5194

Facility Type: Ambulatory Surgery Center

Certificate Type: Waiver

NPI Number: 1922055235

Taxonomy: 261QA1903X - Clinic/Center

CLIA Record

Field Name	Field Value
CLIA Number	21D1048999
LAB Type	Ambulatory Surgery Center
Facility Name	MID-ATLANTIC SURGERY PAVILION
Street	1111 BEARDS HILL ROAD STE 700
City	ABERDEEN
State	MD
ZIP	21001
Phone	410 935-5194
CertificateType	4
CertificateEffectiveDate	12/19/2023
CertificateExpirationDate	12/18/2025
FacilityType	Waiver

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