21D2043928 CLIA NUMBER - HEALTHPORT

Laboratory Demographics

  • CLIA Code: 21D2043928
  • Facility Name: HEALTHPORT
  • Facility Address: 505 E MAIN STREET
    SALISBURY, MD
    ZIP 21804
  • Facility Phone: 410 341-3420
  • Facility Type: Community Clinic
  • Facility Type: Microscopy
  • Lab Director: SHASHIKALA K. VENKATACHALAPATHY MD
  • NPI Number: 1780950725
  • Taxonomy: 261QP2300X - Clinic/Center

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CLIA Record

Field Name Field Value
CLIA Number 21D2043928
LAB Type Community Clinic
Facility Name HEALTHPORT
Street 505 E MAIN STREET
City SALISBURY
State MD
ZIP 21804
Phone 410 341-3420
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 7/13/2024
Certificate Expiration Date 7/12/2026
Facility Type Community Clinic
Lab Director SHASHIKALA K. VENKATACHALAPATHY MD

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