21D2089125 CLIA NUMBER - PRIME MEDICINE LLC

Laboratory Demographics

  • CLIA Code: 21D2089125
  • Facility Name: PRIME MEDICINE LLC
  • Facility Address: 12150 ANNAPOILS ROAD SUITE 308
    GLENN DALE, MD
    ZIP 20769
  • Facility Phone: 301 565-2250
  • Facility Type: Physician Office
  • Facility Type: Waiver
  • Lab Director: FARHAD JAMALI MD
  • NPI Number: 1134319395
  • Taxonomy: 207R00000X - Internal Medicine

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CLIA Record

Field Name Field Value
CLIA Number 21D2089125
LAB Type Physician Office
Facility Name PRIME MEDICINE LLC
Street 12150 ANNAPOILS ROAD SUITE 308
City GLENN DALE
State MD
ZIP 20769
Phone 301 565-2250
Certificate Type Certificate of Waiver
Certificate Type Description This certificate is issued to a laboratory to perform only waived tests.
Certificate Effective Date 12/19/2024
Certificate Expiration Date 12/18/2026
Facility Type Physician Office
Lab Director FARHAD JAMALI MD

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