21D2017698 CLIA NUMBER - JOSE E GONZALEZ MD PA

Laboratory Demographics

  • CLIA Code: 21D2017698
  • Facility Name: JOSE E GONZALEZ MD PA
  • Facility Address: 1643 LIBERTY ROAD UNIT 106
    ELDERSBURG, MD
    ZIP 21784
  • Facility Phone: 410 795-4020
  • Facility Type: Physician Office
  • Facility Type: Waiver
  • Lab Director: DR. JOSE GONZALEZ
  • NPI Number: 1346459757
  • Taxonomy: 174400000X - Specialist

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CLIA Record

Field Name Field Value
CLIA Number 21D2017698
LAB Type Physician Office
Facility Name JOSE E GONZALEZ MD PA
Street 1643 LIBERTY ROAD UNIT 106
City ELDERSBURG
State MD
ZIP 21784
Phone 410 795-4020
Certificate Type Certificate of Waiver
Certificate Type Description This certificate is issued to a laboratory to perform only waived tests.
Certificate Effective Date 12/13/2024
Certificate Expiration Date 12/12/2026
Facility Type Physician Office
Lab Director DR. JOSE GONZALEZ

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