21D1099887 CLIA NUMBER - FREDERICK HEALTH MEDICAL GROUP

Laboratory Demographics

  • CLIA Code: 21D1099887
  • Facility Name: FREDERICK HEALTH MEDICAL GROUP
  • Facility Address: 3430 WORTHINGTON BLVD
    FREDERICK, MD
    ZIP 21704
  • Facility Phone: 240 566-5400
  • Facility Type: Ancillary Testing Site in Health Care Center
  • Facility Type: Waiver
  • Lab Director: DR. ALICE ESAME
  • NPI Number: 1528282431
  • Taxonomy: 1223G0001X - Dentist

Map and Directions

Get Directions

CLIA Record

Field Name Field Value
CLIA Number 21D1099887
LAB Type Ancillary Testing Site in Health Care Center
Facility Name FREDERICK HEALTH MEDICAL GROUP
Street 3430 WORTHINGTON BLVD
City FREDERICK
State MD
ZIP 21704
Phone 240 566-5400
Certificate Type Certificate of Waiver
Certificate Type Description This certificate is issued to a laboratory to perform only waived tests.
Certificate Effective Date 5/26/2025
Certificate Expiration Date 5/25/2027
Facility Type Ancillary Testing Site in Health Care Center
Lab Director DR. ALICE ESAME

Download Record

Download this CLIA record record in Text format: Export

Download this CLIA record record in Excel (CSV) format: Export

Download this CLIA record record in XML format: Export

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