21D2095112 CLIA NUMBER - CENTER FOR PAIN MANAGEMENT, LLC

Laboratory Demographics

  • CLIA Code: 21D2095112
  • Facility Name: CENTER FOR PAIN MANAGEMENT, LLC
  • Facility Address: 5010 REGENCY PLACE SUITE 202A
    WHITE PLAINS, MD
    ZIP 20695
  • Facility Phone: 301 645-1523
  • Facility Type: Physician Office
  • Facility Type: Waiver
  • Lab Director: RICHARD J. BROUILETTE
  • NPI Number: 1437458809
  • Taxonomy: 208VP0014X - Pain Medicine

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CLIA Record

Field Name Field Value
CLIA Number 21D2095112
LAB Type Physician Office
Facility Name CENTER FOR PAIN MANAGEMENT, LLC
Street 5010 REGENCY PLACE SUITE 202A
City WHITE PLAINS
State MD
ZIP 20695
Phone 301 645-1523
Certificate Type Certificate of Waiver
Certificate Type Description This certificate is issued to a laboratory to perform only waived tests.
Certificate Effective Date 4/30/2025
Certificate Expiration Date 4/29/2027
Facility Type Physician Office
Lab Director RICHARD J. BROUILETTE

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