21D2040539 CLIA NUMBER - SHADY GROVE MINIMALLY INVASIVE AND GYNECOLOGY CARE

Laboratory Demographics

  • CLIA Code: 21D2040539
  • Facility Name: SHADY GROVE MINIMALLY INVASIVE AND GYNECOLOGY CARE
  • Facility Address: 2403 RESEARCH BLVD STE 200
    ROCKVILLE, MD
    ZIP 20850
  • Facility Phone: 240 912-4546
  • Facility Type: Physician Office
  • Facility Type: Microscopy
  • Lab Director: SHABNAM DADGAR
  • NPI Number: 1194222620
  • Taxonomy: 207V00000X - Obstetrics & Gynecology

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CLIA Record

Field Name Field Value
CLIA Number 21D2040539
LAB Type Physician Office
Facility Name SHADY GROVE MINIMALLY INVASIVE AND GYNECOLOGY CARE
Street 2403 RESEARCH BLVD STE 200
City ROCKVILLE
State MD
ZIP 20850
Phone 240 912-4546
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 12/14/2023
Certificate Expiration Date 12/13/2025
Facility Type Physician Office
Lab Director SHABNAM DADGAR

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