21D2107344 CLIA NUMBER - THE PRIMARY CARE GROUP OF MARYLAND

Laboratory Demographics

  • CLIA Code: 21D2107344
  • Facility Name: THE PRIMARY CARE GROUP OF MARYLAND
  • Facility Address: 85 KINDRED WAY #101
    GLEN BURNIE, MD
    ZIP 21061
  • Facility Phone: 410 553-6360
  • Facility Type: Physician Office
  • Facility Type: Waiver
  • Lab Director: NNAEMEKA AGAJELU
  • NPI Number: 1548449275
  • Taxonomy: 207R00000X - Internal Medicine

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CLIA Record

Field Name Field Value
CLIA Number 21D2107344
LAB Type Physician Office
Facility Name THE PRIMARY CARE GROUP OF MARYLAND
Street 85 KINDRED WAY #101
City GLEN BURNIE
State MD
ZIP 21061
Phone 410 553-6360
Certificate Type Certificate of Waiver
Certificate Type Description This certificate is issued to a laboratory to perform only waived tests.
Certificate Effective Date 12/13/2024
Certificate Expiration Date 12/12/2026
Facility Type Physician Office
Lab Director NNAEMEKA AGAJELU

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