21D2118842 CLIA NUMBER - GREATER BALTIMORE COLORECTAL SPECIALIST, LLC

Laboratory Demographics

CLIA Number: 21D2118842

Facility Name: GREATER BALTIMORE COLORECTAL SPECIALIST, LLC

Facility Address:
6569 NORTH CHARLES STREET SUITE 502
BALTIMORE, MD
ZIP 21204
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Facility Phone Number: 410 296-1661

Facility Type: Physician Office

Certificate Type: Certificate of Compliance

NPI Number: 1932425634

Taxonomy: 208C00000X - Colon & Rectal Surgery
A colon and rectal surgeon is trained to diagnose and treat various diseases of the intestinal tract, colon, rectum, anal canal and perianal area by medical and surgical means. This specialist also deals with other organs and tissues (such as the liver, urinary and female reproductive system) involved with primary intestinal disease.

CLIA Record

Field Name	Field Value
CLIA Number	21D2118842
LAB Type	Physician Office
Facility Name	GREATER BALTIMORE COLORECTAL SPECIALIST, LLC
Street	6569 NORTH CHARLES STREET SUITE 502
City	BALTIMORE
State	MD
ZIP	21204
Phone	410 296-1661
CertificateType	2
CertificateEffectiveDate	6/5/2023
CertificateExpirationDate	6/4/2025
FacilityType	Compliance

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