21D2057588 CLIA NUMBER - MAN ALIVE INC

Laboratory Demographics

  • CLIA Code: 21D2057588
  • Facility Name: MAN ALIVE INC
  • Facility Address: 2117 MARYLAND AVENUE
    BALTIMORE, MD
    ZIP 21218
  • Facility Phone: 410 837-4292
  • Facility Type: Other - OPIOID TREATMENT PROG
  • Facility Type: Waiver
  • Lab Director: UGANDHAR VEMULAPALLI
  • NPI Number: 1437488053
  • Taxonomy: 101YM0800X - Counselor

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CLIA Record

Field Name Field Value
CLIA Number 21D2057588
LAB Type Other - OPIOID TREATMENT PROG
Facility Name MAN ALIVE INC
Street 2117 MARYLAND AVENUE
City BALTIMORE
State MD
ZIP 21218
Phone 410 837-4292
Certificate Type Certificate of Waiver
Certificate Type Description This certificate is issued to a laboratory to perform only waived tests.
Certificate Effective Date 4/19/2025
Certificate Expiration Date 4/18/2027
Facility Type Other - OPIOID TREATMENT PROG
Lab Director UGANDHAR VEMULAPALLI

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