21D1087474 CLIA NUMBER - MARYLAND CORRECTIONAL INSTITUTE JESSUP (MCIJ)

Laboratory Demographics

  • CLIA Code: 21D1087474
  • Facility Name: MARYLAND CORRECTIONAL INSTITUTE JESSUP (MCIJ)
  • Facility Address: 7931 BROCKBRIDGE ROAD
    JESSUP, MD
    ZIP 20794
  • Facility Phone: 410 540-6774
  • Facility Type: Prison
  • Facility Type: Waiver
  • Lab Director: DR. SHARON L. BAUCOM
  • NPI Number: 1629508478
  • Taxonomy: 333600000X - Pharmacy

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CLIA Record

Field Name Field Value
CLIA Number 21D1087474
LAB Type Prison
Facility Name MARYLAND CORRECTIONAL INSTITUTE JESSUP (MCIJ)
Street 7931 BROCKBRIDGE ROAD
City JESSUP
State MD
ZIP 20794
Phone 410 540-6774
Certificate Type Certificate of Waiver
Certificate Type Description This certificate is issued to a laboratory to perform only waived tests.
Certificate Effective Date 8/5/2024
Certificate Expiration Date 8/4/2026
Facility Type Prison
Lab Director DR. SHARON L. BAUCOM

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