21D1054321 CLIA NUMBER - SURESH KUMAR MUTTATH LLC

Laboratory Demographics

  • CLIA Code: 21D1054321
  • Facility Name: SURESH KUMAR MUTTATH LLC
  • Facility Address: 5711 SARVIS AVENUE SUITE 200
    RIVERDALE, MD
    ZIP 20737
  • Facility Phone: 301 277-8100
  • Facility Type: Physician Office
  • Facility Type: Waiver
  • Lab Director: SURESHKUMAR MUTTATH MD
  • NPI Number: 1275599458
  • Taxonomy: 207R00000X - Internal Medicine

Map and Directions

Get Directions

CLIA Record

Field Name Field Value
CLIA Number 21D1054321
LAB Type Physician Office
Facility Name SURESH KUMAR MUTTATH LLC
Street 5711 SARVIS AVENUE SUITE 200
City RIVERDALE
State MD
ZIP 20737
Phone 301 277-8100
Certificate Type Certificate of Waiver
Certificate Type Description This certificate is issued to a laboratory to perform only waived tests.
Certificate Effective Date 1/25/2025
Certificate Expiration Date 1/24/2027
Facility Type Physician Office
Lab Director SURESHKUMAR MUTTATH MD

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: 3/20/2025