21D2094252 CLIA NUMBER - TIDALHEALTH PRIMARY CARE

Laboratory Demographics

  • CLIA Code: 21D2094252
  • Facility Name: TIDALHEALTH PRIMARY CARE
  • Facility Address: 1639 WOODBROOKE DRIVE
    SALISBURY, MD
    ZIP 21804
  • Facility Phone: 410 912-5785
  • Facility Type: Physician Office
  • Facility Type: Waiver
  • Lab Director: DANIELLE L. GIDDINS
  • NPI Number: 1104453208
  • Taxonomy: 207Q00000X - Family Medicine

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CLIA Record

Field Name Field Value
CLIA Number 21D2094252
LAB Type Physician Office
Facility Name TIDALHEALTH PRIMARY CARE
Street 1639 WOODBROOKE DRIVE
City SALISBURY
State MD
ZIP 21804
Phone 410 912-5785
Certificate Type Certificate of Waiver
Certificate Type Description This certificate is issued to a laboratory to perform only waived tests.
Certificate Effective Date 4/14/2025
Certificate Expiration Date 4/13/2027
Facility Type Physician Office
Lab Director DANIELLE L. GIDDINS

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