21D1071658 CLIA NUMBER - WHITE MARSH SURGERY CENTER

Laboratory Demographics

  • CLIA Code: 21D1071658
  • Facility Name: WHITE MARSH SURGERY CENTER
  • Facility Address: 4924 CAMPBELL BLVD #250
    NOTTINGHAM, MD
    ZIP 21236
  • Facility Phone: 443 442-2700
  • Facility Type: Ambulatory Surgery Center
  • Facility Type: Waiver
  • Lab Director: DR. LISA ISHII
  • NPI Number: 1043466147
  • Taxonomy: 2084P0800X - Psychiatry & Neurology

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CLIA Record

Field Name Field Value
CLIA Number 21D1071658
LAB Type Ambulatory Surgery Center
Facility Name WHITE MARSH SURGERY CENTER
Street 4924 CAMPBELL BLVD #250
City NOTTINGHAM
State MD
ZIP 21236
Phone 443 442-2700
Certificate Type Certificate of Waiver
Certificate Type Description This certificate is issued to a laboratory to perform only waived tests.
Certificate Effective Date 7/30/2025
Certificate Expiration Date 7/29/2027
Facility Type Ambulatory Surgery Center
Lab Director DR. LISA ISHII

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