21D1097216 CLIA NUMBER - CALVERT INTERNAL MEDICINE GROUP

Laboratory Demographics

  • CLIA Code: 21D1097216
  • Facility Name: CALVERT INTERNAL MEDICINE GROUP
  • Facility Address: 110 HOSPITAL RD STE 303
    PRINCE FREDERICK, MD
    ZIP 20678
  • Facility Phone: 410 535-2005
  • Facility Type: Physician Office
  • Facility Type: Microscopy
  • Lab Director: DR. PAUL V. POMILLA
  • NPI Number: 1376936823
  • Taxonomy: 363LG0600X - Nurse Practitioner

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CLIA Record

Field Name Field Value
CLIA Number 21D1097216
LAB Type Physician Office
Facility Name CALVERT INTERNAL MEDICINE GROUP
Street 110 HOSPITAL RD STE 303
City PRINCE FREDERICK
State MD
ZIP 20678
Phone 410 535-2005
Certificate Type Certificate for Provider-Performed Microscopy Procedures (PPMP)
Certificate Type Description This certificate is issued to a laboratory in which a physician, midlevel practitioner or dentist performs no tests other than the microscopy procedures. This certificate permits the laboratory to also perform waived tests.
Certificate Effective Date 3/20/2025
Certificate Expiration Date 3/19/2027
Facility Type Physician Office
Lab Director DR. PAUL V. POMILLA

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