21D1075977 CLIA NUMBER - BALLENGER CREEK DIALYSIS

Laboratory Demographics

  • CLIA Code: 21D1075977
  • Facility Name: BALLENGER CREEK DIALYSIS
  • Facility Address: 5205 CHAIRMANS COURT STE 101
    FREDERICK, MD
    ZIP 21703
  • Facility Phone: 301 662-6572
  • Facility Type: End Stage Renal Disease Dialysis Facility
  • Facility Type: Waiver
  • Lab Director: ROHAN R. RENGEN
  • NPI Number: 1902184625
  • Taxonomy: 261QE0700X - Clinic/Center

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CLIA Record

Field Name Field Value
CLIA Number 21D1075977
LAB Type End Stage Renal Disease Dialysis Facility
Facility Name BALLENGER CREEK DIALYSIS
Street 5205 CHAIRMANS COURT STE 101
City FREDERICK
State MD
ZIP 21703
Phone 301 662-6572
Certificate Type Certificate of Waiver
Certificate Type Description This certificate is issued to a laboratory to perform only waived tests.
Certificate Effective Date 11/2/2023
Certificate Expiration Date 11/1/2025
Facility Type End Stage Renal Disease Dialysis Facility
Lab Director ROHAN R. RENGEN

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