21D1106577 CLIA NUMBER - MAPLE LAWN SURGERY CENTER LLC

Laboratory Demographics

  • CLIA Code: 21D1106577
  • Facility Name: MAPLE LAWN SURGERY CENTER LLC
  • Facility Address: 7625 MAPLE LAWN BLVD STE 110
    FULTON, MD
    ZIP 20759
  • Facility Phone: 301 490-5025
  • Facility Type: Ambulatory Surgery Center
  • Facility Type: Waiver
  • Lab Director: DR. JERRY R. THOMAS II
  • NPI Number: 1801266838
  • Taxonomy: 2084N0400X - Psychiatry & Neurology

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CLIA Record

Field Name Field Value
CLIA Number 21D1106577
LAB Type Ambulatory Surgery Center
Facility Name MAPLE LAWN SURGERY CENTER LLC
Street 7625 MAPLE LAWN BLVD STE 110
City FULTON
State MD
ZIP 20759
Phone 301 490-5025
Certificate Type Certificate of Waiver
Certificate Type Description This certificate is issued to a laboratory to perform only waived tests.
Certificate Effective Date 10/19/2025
Certificate Expiration Date 10/18/2027
Facility Type Ambulatory Surgery Center
Lab Director DR. JERRY R. THOMAS II

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