21D1052212 CLIA NUMBER - ACTIVE DAY MD INC/ACTIVE DAY OF BALTIMORE

Laboratory Demographics

  • CLIA Code: 21D1052212
  • Facility Name: ACTIVE DAY MD INC/ACTIVE DAY OF BALTIMORE
  • Facility Address: 1430 JOH AVENUE STE A
    BALTIMORE, MD
    ZIP 21227
  • Facility Phone: 410 242-0379
  • Facility Type: Other - MEDICAL ADULT DAY CENTER
  • Facility Type: Waiver
  • Lab Director: DR. BRIAN C. WALLACE
  • NPI Number: 1760523542
  • Taxonomy: 261QA0600X - Clinic/Center

Map and Directions

Get Directions

CLIA Record

Field Name Field Value
CLIA Number 21D1052212
LAB Type Other - MEDICAL ADULT DAY CENTER
Facility Name ACTIVE DAY MD INC/ACTIVE DAY OF BALTIMORE
Street 1430 JOH AVENUE STE A
City BALTIMORE
State MD
ZIP 21227
Phone 410 242-0379
Certificate Type Certificate of Waiver
Certificate Type Description This certificate is issued to a laboratory to perform only waived tests.
Certificate Effective Date 9/17/2025
Certificate Expiration Date 9/16/2027
Facility Type Other - MEDICAL ADULT DAY CENTER
Lab Director DR. BRIAN C. WALLACE

Download Record

Download this CLIA record record in Text format: Export

Download this CLIA record record in Excel (CSV) format: Export

Download this CLIA record record in XML format: Export

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