21D2101795 CLIA NUMBER - TIDEWATER DERMATOLOGY

Laboratory Demographics

  • CLIA Code: 21D2101795
  • Facility Name: TIDEWATER DERMATOLOGY
  • Facility Address: 314 FRANKLIN AVE, SUITE 401
    BERLIN, MD
    ZIP 21811
  • Facility Phone: 410 641-2222
  • Facility Type: Physician Office
  • Facility Type: Microscopy
  • Lab Director: ERIN L. SPILLANE
  • NPI Number: 1891188991
  • Taxonomy: 207N00000X - Dermatology

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CLIA Record

Field Name Field Value
CLIA Number 21D2101795
LAB Type Physician Office
Facility Name TIDEWATER DERMATOLOGY
Street 314 FRANKLIN AVE, SUITE 401
City BERLIN
State MD
ZIP 21811
Phone 410 641-2222
Certificate Type Certificate for Provider-Performed Microscopy Procedures (PPMP)
Certificate Type Description This certificate is issued to a laboratory in which a physician, midlevel practitioner or dentist performs no tests other than the microscopy procedures. This certificate permits the laboratory to also perform waived tests.
Certificate Effective Date 9/10/2025
Certificate Expiration Date 9/9/2027
Facility Type Physician Office
Lab Director ERIN L. SPILLANE

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