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

Laboratory Demographics

  • CLIA Code: 21D2113474
  • Facility Name: LIFEBRIDGE SUBURBAN PHYS GRP LLC/DR ANISA MIRZA
  • Facility Address: 849 FAIRMOUNT AVE SUITE 100B
    TOWSON, MD
    ZIP 21286
  • Facility Phone: (410) 469-4981
  • Facility Type: Physician Office
  • Facility Type: Waiver
  • Lab Director: DR. CAROL I. REYNOLDS-FREEMAN

Map and Directions

Get Directions

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 4104694981
Certificate Type Certificate of Waiver
Certificate Type Description This certificate is issued to a laboratory to perform only waived tests.
Certificate Effective Date 5/24/2024
Certificate Expiration Date 5/23/2026
Facility Type Physician Office
Lab Director DR. CAROL I. REYNOLDS-FREEMAN

Download Record

Download this CLIA record record in Text format: Export

Download this CLIA record record in Excel (CSV) format: Export

Download this CLIA record record in XML format: Export

This page was last updated on: 5/18/2026