21D2017696 CLIA NUMBER - ANNE ARUNDEL DERMATOLOGY

Laboratory Demographics

  • CLIA Code: 21D2017696
  • Facility Name: ANNE ARUNDEL DERMATOLOGY
  • Facility Address: 6163 EXECUTIVE BLVD
    ROCKVILLE, MD
    ZIP 20852
  • Facility Phone: (855) 314-1424
  • Facility Type: Physician Office
  • Facility Type: Microscopy
  • Lab Director: DR. RONALD PRUSSICK
  • NPI Number: 1063481703
  • Taxonomy: 207N00000X - Dermatology

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CLIA Record

Field Name Field Value
CLIA Number 21D2017696
LAB Type Physician Office
Facility Name ANNE ARUNDEL DERMATOLOGY
Street 6163 EXECUTIVE BLVD
City ROCKVILLE
State MD
ZIP 20852
Phone 8553141424
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 12/16/2024
Certificate Expiration Date 12/15/2026
Facility Type Physician Office
Lab Director DR. RONALD PRUSSICK

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This page was last updated on: 5/18/2026