21D2079757 CLIA NUMBER - PARK PEDIATRICS

Laboratory Demographics

  • CLIA Code: 21D2079757
  • Facility Name: PARK PEDIATRICS
  • Facility Address: 501 N FREDERICK AVE #320
    GAITHERSBURG, MD
    ZIP 20877
  • Facility Phone: 301 670-1873
  • Facility Type: Physician Office
  • Facility Type: Waiver
  • Lab Director: LAVANYA SITHANANDAM
  • NPI Number: 1538979117
  • Taxonomy: 208000000X - Pediatrics

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CLIA Record

Field Name Field Value
CLIA Number 21D2079757
LAB Type Physician Office
Facility Name PARK PEDIATRICS
Street 501 N FREDERICK AVE #320
City GAITHERSBURG
State MD
ZIP 20877
Phone 301 670-1873
Certificate Type Certificate of Waiver
Certificate Type Description This certificate is issued to a laboratory to perform only waived tests.
Certificate Effective Date 6/24/2024
Certificate Expiration Date 6/23/2026
Facility Type Physician Office
Lab Director LAVANYA SITHANANDAM

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