21D1056559 CLIA NUMBER - MICHELLE TAN MD DEER PARK INTERNAL MED

Laboratory Demographics

  • CLIA Code: 21D1056559
  • Facility Name: MICHELLE TAN MD DEER PARK INTERNAL MED
  • Facility Address: 600 S FREDERICK AVE STE 302
    GAITHERSBURG, MD
    ZIP 20877
  • Facility Phone: 301 208-1188
  • Facility Type: Physician Office
  • Facility Type: Waiver
  • Lab Director: MICHELLE TAN
  • NPI Number: 1467411959
  • Taxonomy: 207R00000X - Internal Medicine

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CLIA Record

Field Name Field Value
CLIA Number 21D1056559
LAB Type Physician Office
Facility Name MICHELLE TAN MD DEER PARK INTERNAL MED
Street 600 S FREDERICK AVE STE 302
City GAITHERSBURG
State MD
ZIP 20877
Phone 301 208-1188
Certificate Type Certificate of Waiver
Certificate Type Description This certificate is issued to a laboratory to perform only waived tests.
Certificate Effective Date 7/19/2024
Certificate Expiration Date 7/18/2026
Facility Type Physician Office
Lab Director MICHELLE TAN

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