21D2059948 CLIA NUMBER - MARYLAND MEDICAL SERVICES LLC

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Laboratory Demographics

CLIA Number: 21D2059948

Facility Name: MARYLAND MEDICAL SERVICES LLC

Facility Address:
1090 WEST PATRICK STREET UNIT 2A
FREDERICK, MD
ZIP 21703
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Facility Phone Number: 301 662-0757

Facility Type: Physician Office

Certificate Type: Waiver

NPI Number: 1306180013

Taxonomy: 261QP2300X - Clinic/Center

CLIA Record

Field Name	Field Value
CLIA Number	21D2059948
LAB Type	Physician Office
Facility Name	MARYLAND MEDICAL SERVICES LLC
Street	1090 WEST PATRICK STREET UNIT 2A
City	FREDERICK
State	MD
ZIP	21703
Phone	301 662-0757
CertificateType	4
CertificateEffectiveDate	10/2/2023
CertificateExpirationDate	10/1/2025
FacilityType	Waiver

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