21D2091739 CLIA NUMBER - ATLANTIC GENERAL PRIMARY CARE AND PEDIATRICS

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Laboratory Demographics

CLIA Number: 21D2091739

Facility Name: ATLANTIC GENERAL PRIMARY CARE AND PEDIATRICS

Facility Address:
12308 OCEAN GATEWAY, UNIT 1
OCEAN CITY, MD
ZIP 21842
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Facility Phone Number: 410 641-9362

Facility Type: Physician Office

Certificate Type: Waiver

NPI Number: 1861891368

Taxonomy: 261QU0200X - Clinic/Center

CLIA Record

Field Name	Field Value
CLIA Number	21D2091739
LAB Type	Physician Office
Facility Name	ATLANTIC GENERAL PRIMARY CARE AND PEDIATRICS
Street	12308 OCEAN GATEWAY, UNIT 1
City	OCEAN CITY
State	MD
ZIP	21842
Phone	410 641-9362
CertificateType	4
CertificateEffectiveDate	2/18/2023
CertificateExpirationDate	2/17/2025
FacilityType	Waiver

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