21D2079552 CLIA NUMBER - MEDSTAR UNION MEMORIAL ADULT MEDICINE SPECIALIST

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Laboratory Demographics

CLIA Number: 21D2079552

Facility Name: MEDSTAR UNION MEMORIAL ADULT MEDICINE SPECIALIST

Facility Address:
2800 KIRK AVE
BALTIMORE, MD
ZIP 21218
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Facility Phone Number: 410 387-0282

Facility Type: Physician Office

Certificate Type: Microscopy

NPI Number: 1063655611

Taxonomy: 282NR1301X - General Acute Care Hospital

CLIA Record

Field Name	Field Value
CLIA Number	21D2079552
LAB Type	Physician Office
Facility Name	MEDSTAR UNION MEMORIAL ADULT MEDICINE SPECIALIST
Street	2800 KIRK AVE
City	BALTIMORE
State	MD
ZIP	21218
Phone	410 387-0282
CertificateType	3
CertificateEffectiveDate	6/18/2022
CertificateExpirationDate	6/17/2024
FacilityType	PPMP

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