21D1051159 CLIA NUMBER - BAYSIDE PRIMARY CARE

Laboratory Demographics

  • CLIA Code: 21D1051159
  • Facility Name: BAYSIDE PRIMARY CARE
  • Facility Address: 489 MAIN ST STE 102
    PRINCE FREDERICK, MD
    ZIP 20678
  • Facility Phone: 410 414-5633
  • Facility Type: Physician Office
  • Facility Type: Microscopy
  • Lab Director: DEBORAH R. BROWER
  • NPI Number: 1093834830
  • Taxonomy: 174400000X - Specialist

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CLIA Record

Field Name Field Value
CLIA Number 21D1051159
LAB Type Physician Office
Facility Name BAYSIDE PRIMARY CARE
Street 489 MAIN ST STE 102
City PRINCE FREDERICK
State MD
ZIP 20678
Phone 410 414-5633
Certificate Type Certificate for Provider-Performed Microscopy Procedures (PPMP)
Certificate Type Description This certificate is issued to a laboratory in which a physician, midlevel practitioner or dentist performs no tests other than the microscopy procedures. This certificate permits the laboratory to also perform waived tests.
Certificate Effective Date 2/23/2024
Certificate Expiration Date 2/22/2026
Facility Type Physician Office
Lab Director DEBORAH R. BROWER

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