21D1081453 CLIA NUMBER - GAITHERSBURG FAMILY MEDICINE

Laboratory Demographics

  • CLIA Code: 21D1081453
  • Facility Name: GAITHERSBURG FAMILY MEDICINE
  • Facility Address: 604 S FREDERICK AVENUE
    GAITHERSBURG, MD
    ZIP 20877
  • Facility Phone: 240 404-6423
  • Facility Type: Physician Office
  • Facility Type: Waiver
  • Lab Director: WEI XU
  • NPI Number: 1871772897
  • Taxonomy: 207Q00000X - Family Medicine

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CLIA Record

Field Name Field Value
CLIA Number 21D1081453
LAB Type Physician Office
Facility Name GAITHERSBURG FAMILY MEDICINE
Street 604 S FREDERICK AVENUE
City GAITHERSBURG
State MD
ZIP 20877
Phone 240 404-6423
Certificate Type Certificate of Waiver
Certificate Type Description This certificate is issued to a laboratory to perform only waived tests.
Certificate Effective Date 3/18/2024
Certificate Expiration Date 3/17/2026
Facility Type Physician Office
Lab Director WEI XU

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