21D2029932 CLIA NUMBER - WATCHEMSPROUT PEDIATRICS

Laboratory Demographics

  • CLIA Code: 21D2029932
  • Facility Name: WATCHEMSPROUT PEDIATRICS
  • Facility Address: 1190 NORTHERN PKWY STE 101
    BALTIMORE, MD
    ZIP 21210
  • Facility Phone: 443 858-7337
  • Facility Type: Physician Office
  • Facility Type: Waiver
  • Lab Director: CELIA BARDOFF CRNP
  • NPI Number: 1093000432
  • Taxonomy: 363LP0200X - Nurse Practitioner

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CLIA Record

Field Name Field Value
CLIA Number 21D2029932
LAB Type Physician Office
Facility Name WATCHEMSPROUT PEDIATRICS
Street 1190 NORTHERN PKWY STE 101
City BALTIMORE
State MD
ZIP 21210
Phone 443 858-7337
Certificate Type Certificate of Waiver
Certificate Type Description This certificate is issued to a laboratory to perform only waived tests.
Certificate Effective Date 9/17/2025
Certificate Expiration Date 9/16/2027
Facility Type Physician Office
Lab Director CELIA BARDOFF CRNP

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