21D1085746 CLIA NUMBER - PATUXENT MEDICAL CLINIC

Laboratory Demographics

  • CLIA Code: 21D1085746
  • Facility Name: PATUXENT MEDICAL CLINIC
  • Facility Address: 23127 THREE NOTCH ROAD #104
    CALIFORNIA, MD
    ZIP 20619
  • Facility Phone: 301 863-8101
  • Facility Type: Physician Office
  • Facility Type: Waiver
  • Lab Director: KATHERINE A. MARTIN DO
  • NPI Number: 1457737561
  • Taxonomy: 1223X0400X - Dentist

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CLIA Record

Field Name Field Value
CLIA Number 21D1085746
LAB Type Physician Office
Facility Name PATUXENT MEDICAL CLINIC
Street 23127 THREE NOTCH ROAD #104
City CALIFORNIA
State MD
ZIP 20619
Phone 301 863-8101
Certificate Type Certificate of Waiver
Certificate Type Description This certificate is issued to a laboratory to perform only waived tests.
Certificate Effective Date 1/29/2025
Certificate Expiration Date 1/28/2027
Facility Type Physician Office
Lab Director KATHERINE A. MARTIN DO

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