21D2005801 CLIA NUMBER - PEDIATRIC TLC INC

Laboratory Demographics

  • CLIA Code: 21D2005801
  • Facility Name: PEDIATRIC TLC INC
  • Facility Address: 334 MILL STREET
    HAGERSTOWN, MD
    ZIP 21740
  • Facility Phone: 301 393-9170
  • Facility Type: Physician Office
  • Facility Type: Waiver
  • Lab Director: MOHAMMAD TARIQ
  • NPI Number: 1225573413
  • Taxonomy: 2080A0000X - Pediatrics

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CLIA Record

Field Name Field Value
CLIA Number 21D2005801
LAB Type Physician Office
Facility Name PEDIATRIC TLC INC
Street 334 MILL STREET
City HAGERSTOWN
State MD
ZIP 21740
Phone 301 393-9170
Certificate Type Certificate of Waiver
Certificate Type Description This certificate is issued to a laboratory to perform only waived tests.
Certificate Effective Date 4/6/2024
Certificate Expiration Date 4/5/2026
Facility Type Physician Office
Lab Director MOHAMMAD TARIQ

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