21D2067879 CLIA NUMBER - MMG GI AT MGSH

Laboratory Demographics

  • CLIA Code: 21D2067879
  • Facility Name: MMG GI AT MGSH
  • Facility Address: 5601 LOCH RAVEN BLVD RMB 3
    BALTIMORE, MD
    ZIP 21239
  • Facility Phone: 443 444-4372
  • Facility Type: Physician Office
  • Facility Type: Waiver
  • Lab Director: LAWRENCE MILLS
  • NPI Number: 1023197902
  • Taxonomy: 207RG0100X - Internal Medicine

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CLIA Record

Field Name Field Value
CLIA Number 21D2067879
LAB Type Physician Office
Facility Name MMG GI AT MGSH
Street 5601 LOCH RAVEN BLVD RMB 3
City BALTIMORE
State MD
ZIP 21239
Phone 443 444-4372
Certificate Type Certificate of Waiver
Certificate Type Description This certificate is issued to a laboratory to perform only waived tests.
Certificate Effective Date 10/24/2023
Certificate Expiration Date 10/23/2025
Facility Type Physician Office
Lab Director LAWRENCE MILLS

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