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21D2113474 CLIA NUMBER - LIFEBRIDGE SUBURBAN PHYS GRP LLC/DR ANISA MIRZA

Laboratory Demographics

CLIA Number: 21D2113474

Facility Name: LIFEBRIDGE SUBURBAN PHYS GRP LLC/DR ANISA MIRZA

Facility Address:
849 FAIRMOUNT AVE SUITE 100B
TOWSON, MD
ZIP 21286
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Facility Phone Number: 410 469-4981

Facility Type: Physician Office

Certificate Type: Waiver
NPI Number: 1508225798

Taxonomy: 207R00000X - Internal Medicine
A physician who provides long-term, comprehensive care in the office and the hospital, managing both common and complex illness of adolescents, adults and the elderly. Internists are trained in the diagnosis and treatment of cancer, infections and diseases affecting the heart, blood, kidneys, joints and digestive, respiratory and vascular systems. They are also trained in the essentials of primary care internal medicine, which incorporates an understanding of disease prevention, wellness, substance abuse, mental health and effective treatment of common problems of the eyes, ears, skin, nervous system and reproductive organs.

CLIA Record

Field Name Field Value
CLIA Number 21D2113474
LAB Type Physician Office
Facility Name LIFEBRIDGE SUBURBAN PHYS GRP LLC/DR ANISA MIRZA
Street 849 FAIRMOUNT AVE SUITE 100B
City TOWSON
State MD
ZIP 21286
Phone 410 469-4981
CertificateType 4
CertificateEffectiveDate 5/24/2022
CertificateExpirationDate 5/23/2024
FacilityType Waiver

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This page was last updated on: 4/23/2024