21D2006164 CLIA NUMBER - MID-ATLANTIC NEPHROLOGY ASSOCIATES, PA

Laboratory Demographics

  • CLIA Code: 21D2006164
  • Facility Name: MID-ATLANTIC NEPHROLOGY ASSOCIATES, PA
  • Facility Address: 1205 YORK ROAD SUITE 26
    LUTHERVILLE, MD
    ZIP 21093
  • Facility Phone: 410 323-3500
  • Facility Type: Physician Office
  • Facility Type: Microscopy
  • Lab Director: IBIKUNLE O. KOYA
  • NPI Number: 1376600700
  • Taxonomy: 332BN1400X - Durable Medical Equipment & Medical Supplies

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CLIA Record

Field Name Field Value
CLIA Number 21D2006164
LAB Type Physician Office
Facility Name MID-ATLANTIC NEPHROLOGY ASSOCIATES, PA
Street 1205 YORK ROAD SUITE 26
City LUTHERVILLE
State MD
ZIP 21093
Phone 410 323-3500
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 4/14/2024
Certificate Expiration Date 4/13/2026
Facility Type Physician Office
Lab Director IBIKUNLE O. KOYA

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