21D2112261 CLIA NUMBER - SHADY GROVE DERMATOLOGY, LLC

Laboratory Demographics

  • CLIA Code: 21D2112261
  • Facility Name: SHADY GROVE DERMATOLOGY, LLC
  • Facility Address: 15245 SHADY GROVE ROAD, SUITE 370
    ROCKVILLE, MD
    ZIP 20850
  • Facility Phone: 240 246-7417
  • Facility Type: Physician Office
  • Facility Type: Microscopy
  • Lab Director: JOSEF K. YEAGER
  • NPI Number: 1790177210
  • Taxonomy: 174400000X - Specialist

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CLIA Record

Field Name Field Value
CLIA Number 21D2112261
LAB Type Physician Office
Facility Name SHADY GROVE DERMATOLOGY, LLC
Street 15245 SHADY GROVE ROAD, SUITE 370
City ROCKVILLE
State MD
ZIP 20850
Phone 240 246-7417
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 4/26/2024
Certificate Expiration Date 4/25/2026
Facility Type Physician Office
Lab Director JOSEF K. YEAGER

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