21D2058127 CLIA NUMBER - MEDSTAR HEALTH AT LEISURE WORLD BLVD

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Laboratory Demographics

CLIA Number: 21D2058127

Facility Name: MEDSTAR HEALTH AT LEISURE WORLD BLVD

Facility Address:
3305 NORTH LEISURE WORLD BLVD
SILVER SPRING, MD
ZIP 20906
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Facility Phone Number: 301 598-1590

Facility Type: Physician Office

Certificate Type: Waiver

NPI Number: 1518634732

Taxonomy: 261QA1903X - Clinic/Center

CLIA Record

Field Name	Field Value
CLIA Number	21D2058127
LAB Type	Physician Office
Facility Name	MEDSTAR HEALTH AT LEISURE WORLD BLVD
Street	3305 NORTH LEISURE WORLD BLVD
City	SILVER SPRING
State	MD
ZIP	20906
Phone	301 598-1590
CertificateType	4
CertificateEffectiveDate	4/30/2023
CertificateExpirationDate	4/29/2025
FacilityType	Waiver

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