21D2076107 CLIA NUMBER - ADVANCED RADIOLOGY CROSSROADS

Laboratory Demographics

  • CLIA Code: 21D2076107
  • Facility Name: ADVANCED RADIOLOGY CROSSROADS
  • Facility Address: 4801 DORSEY HALL DRIVE STE 101
    ELLICOTT CITY, MD
    ZIP 21042
  • Facility Phone: 443 518-7440
  • Facility Type: Other - OUTPATIENT RADIOLOGY OFFI
  • Facility Type: Waiver
  • Lab Director: FREDERICK K. YEGANEH
  • NPI Number: 1558848747
  • Taxonomy: 207W00000X - Ophthalmology

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CLIA Record

Field Name Field Value
CLIA Number 21D2076107
LAB Type Other - OUTPATIENT RADIOLOGY OFFI
Facility Name ADVANCED RADIOLOGY CROSSROADS
Street 4801 DORSEY HALL DRIVE STE 101
City ELLICOTT CITY
State MD
ZIP 21042
Phone 443 518-7440
Certificate Type Certificate of Waiver
Certificate Type Description This certificate is issued to a laboratory to perform only waived tests.
Certificate Effective Date 4/11/2024
Certificate Expiration Date 4/10/2026
Facility Type Other - OUTPATIENT RADIOLOGY OFFI
Lab Director FREDERICK K. YEGANEH

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