21D2029564 CLIA NUMBER - LEONARDTOWN SURGERY CENTER, LLC

Laboratory Demographics

  • CLIA Code: 21D2029564
  • Facility Name: LEONARDTOWN SURGERY CENTER, LLC
  • Facility Address: 40900 MERCHANTS LANE
    LEONARDTOWN, MD
    ZIP 20650
  • Facility Phone: 301 690-2203
  • Facility Type: Ambulatory Surgery Center
  • Facility Type: Waiver
  • Lab Director: DR. MICHAEL T. TRAVIS
  • NPI Number: 1174802045
  • Taxonomy: 261QA1903X - Clinic/Center

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CLIA Record

Field Name Field Value
CLIA Number 21D2029564
LAB Type Ambulatory Surgery Center
Facility Name LEONARDTOWN SURGERY CENTER, LLC
Street 40900 MERCHANTS LANE
City LEONARDTOWN
State MD
ZIP 20650
Phone 301 690-2203
Certificate Type Certificate of Waiver
Certificate Type Description This certificate is issued to a laboratory to perform only waived tests.
Certificate Effective Date 9/9/2025
Certificate Expiration Date 9/8/2027
Facility Type Ambulatory Surgery Center
Lab Director DR. MICHAEL T. TRAVIS

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