21D2042105 CLIA NUMBER - CENTER FOR PAIN MANAGEMENT, LLC

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Laboratory Demographics

CLIA Number: 21D2042105

Facility Name: CENTER FOR PAIN MANAGEMENT, LLC

Facility Address:
8824 CUNNINGHAM DRIVE STE B
BERWYN HEIGHTS, MD
ZIP 20740
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Facility Phone Number: 240 965-0800

Facility Type: Physician Office

Certificate Type: Waiver

NPI Number: 1992272603

Taxonomy: 332900000X - Non-Pharmacy Dispensing Site
A site other than a pharmacy that dispenses medicinal preparations under the supervision of a physician to patients for self-administration. (e.g. physician offices, ER, Urgent Care Centers, Rural Health Facilities, etc.)

CLIA Record

Field Name	Field Value
CLIA Number	21D2042105
LAB Type	Physician Office
Facility Name	CENTER FOR PAIN MANAGEMENT, LLC
Street	8824 CUNNINGHAM DRIVE STE B
City	BERWYN HEIGHTS
State	MD
ZIP	20740
Phone	240 965-0800
CertificateType	4
CertificateEffectiveDate	5/20/2022
CertificateExpirationDate	5/19/2024
FacilityType	Waiver

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This page was last updated on: 4/23/2024