21D2130492 CLIA NUMBER - FORT WASHINGTON PARK PEDIATRICS PC

Laboratory Demographics

  • CLIA Code: 21D2130492
  • Facility Name: FORT WASHINGTON PARK PEDIATRICS PC
  • Facility Address: 12807 OLD FORT ROAD STE 101
    FORT WASHINGTON, MD
    ZIP 20744
  • Facility Phone: 301 292-7400
  • Facility Type: Physician Office
  • Facility Type: Waiver
  • Lab Director: EDWIN F. AGUILAR-LOPEZ
  • NPI Number: 1487192829
  • Taxonomy: 3336C0003X - Pharmacy

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CLIA Record

Field Name Field Value
CLIA Number 21D2130492
LAB Type Physician Office
Facility Name FORT WASHINGTON PARK PEDIATRICS PC
Street 12807 OLD FORT ROAD STE 101
City FORT WASHINGTON
State MD
ZIP 20744
Phone 301 292-7400
Certificate Type Certificate of Waiver
Certificate Type Description This certificate is issued to a laboratory to perform only waived tests.
Certificate Effective Date 5/10/2025
Certificate Expiration Date 5/9/2027
Facility Type Physician Office
Lab Director EDWIN F. AGUILAR-LOPEZ

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