21D2047668 CLIA NUMBER - PROVIDENCE PAIN MANAGEMENT CENTER

Laboratory Demographics

  • CLIA Code: 21D2047668
  • Facility Name: PROVIDENCE PAIN MANAGEMENT CENTER
  • Facility Address: 6911 LAUREL BOWIE ROAD, STE 212
    BOWIE, MD
    ZIP 20715
  • Facility Phone: 301 755-9500
  • Facility Type: Physician Office
  • Facility Type: Waiver
  • Lab Director: DR. JOSEPH M. OPPONG MD
  • NPI Number: 1902364052
  • Taxonomy: 208VP0014X - Pain Medicine

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CLIA Record

Field Name Field Value
CLIA Number 21D2047668
LAB Type Physician Office
Facility Name PROVIDENCE PAIN MANAGEMENT CENTER
Street 6911 LAUREL BOWIE ROAD, STE 212
City BOWIE
State MD
ZIP 20715
Phone 301 755-9500
Certificate Type Certificate of Waiver
Certificate Type Description This certificate is issued to a laboratory to perform only waived tests.
Certificate Effective Date 10/1/2024
Certificate Expiration Date 9/30/2026
Facility Type Physician Office
Lab Director DR. JOSEPH M. OPPONG MD

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This page was last updated on: 3/20/2025