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21D2079727 CLIA NUMBER - MEDSTAR GOOD SAMARITAN INTERNAL MEDICINE SPECIALIS

Laboratory Demographics

CLIA Number: 21D2079727

Facility Name: MEDSTAR GOOD SAMARITAN INTERNAL MEDICINE SPECIALIS

Facility Address:
5601 LOCH RAVEN BOULEVARD SMYTH 207
BALTIMORE, MD
ZIP 21239
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Facility Phone Number: 443 444-4860

Facility Type: Physician Office

Certificate Type: Waiver
NPI Number: 1811084718

Taxonomy: 282N00000X - General Acute Care Hospital
An acute general hospital is an institution whose primary function is to provide inpatient diagnostic and therapeutic services for a variety of medical conditions, both surgical and non-surgical, to a wide population group. The hospital treats patients in an acute phase of illness or injury, characterized by a single episode or a fairly short duration, from which the patient returns to his or her normal or previous level of activity.

CLIA Record

Field Name Field Value
CLIA Number 21D2079727
LAB Type Physician Office
Facility Name MEDSTAR GOOD SAMARITAN INTERNAL MEDICINE SPECIALIS
Street 5601 LOCH RAVEN BOULEVARD SMYTH 207
City BALTIMORE
State MD
ZIP 21239
Phone 443 444-4860
CertificateType 4
CertificateEffectiveDate 6/24/2022
CertificateExpirationDate 6/23/2024
FacilityType Waiver

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