21D1054580 CLIA NUMBER - KHOSROW DAVACHI, MD PC

Laboratory Demographics

  • CLIA Code: 21D1054580
  • Facility Name: KHOSROW DAVACHI, MD PC
  • Facility Address: 7700 OLD BRANCH AVE AUITE D203
    CLINTON, MD
    ZIP 20735
  • Facility Phone: 301 868-7121
  • Facility Type: Physician Office
  • Facility Type: Microscopy
  • Lab Director: KHOSROW DAVACHI MD
  • NPI Number: 1295812899
  • Taxonomy: 207RN0300X - Internal Medicine

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CLIA Record

Field Name Field Value
CLIA Number 21D1054580
LAB Type Physician Office
Facility Name KHOSROW DAVACHI, MD PC
Street 7700 OLD BRANCH AVE AUITE D203
City CLINTON
State MD
ZIP 20735
Phone 301 868-7121
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 5/25/2024
Certificate Expiration Date 5/24/2026
Facility Type Physician Office
Lab Director KHOSROW DAVACHI MD

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