21D1102610 CLIA NUMBER - INTERNAL MEDICINE PRACTICE

Laboratory Demographics

  • CLIA Code: 21D1102610
  • Facility Name: INTERNAL MEDICINE PRACTICE
  • Facility Address: 246 EASTERN BLVD NORTH STE 103
    HAGERSTOWN, MD
    ZIP 21740
  • Facility Phone: (301) 739-0240
  • Facility Type: Physician Office
  • Facility Type: Waiver
  • Lab Director: KODUAH PEPRAH
  • NPI Number: 1336231950
  • Taxonomy: 261QP2300X - Clinic/Center

Map and Directions

Get Directions

CLIA Record

Field Name Field Value
CLIA Number 21D1102610
LAB Type Physician Office
Facility Name INTERNAL MEDICINE PRACTICE
Street 246 EASTERN BLVD NORTH STE 103
City HAGERSTOWN
State MD
ZIP 21740
Phone 3017390240
Certificate Type Certificate of Waiver
Certificate Type Description This certificate is issued to a laboratory to perform only waived tests.
Certificate Effective Date 7/22/2025
Certificate Expiration Date 7/21/2027
Facility Type Physician Office
Lab Director KODUAH PEPRAH

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: 5/18/2026