21D2139617 CLIA NUMBER - MATCLINIC PHYSICIANS PRACTICE GROUP, LLC

Laboratory Demographics

  • CLIA Code: 21D2139617
  • Facility Name: MATCLINIC PHYSICIANS PRACTICE GROUP, LLC
  • Facility Address: 40 YORK ROAD SUITE 201
    TOWSON, MD
    ZIP 21204
  • Facility Phone: 410 302-1296
  • Facility Type: Physician Office
  • Facility Type: Waiver
  • Lab Director: DR. ENRIQUE OVIEDO
  • NPI Number: 1295227197
  • Taxonomy: 207R00000X - Internal Medicine

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CLIA Record

Field Name Field Value
CLIA Number 21D2139617
LAB Type Physician Office
Facility Name MATCLINIC PHYSICIANS PRACTICE GROUP, LLC
Street 40 YORK ROAD SUITE 201
City TOWSON
State MD
ZIP 21204
Phone 410 302-1296
Certificate Type Certificate of Waiver
Certificate Type Description This certificate is issued to a laboratory to perform only waived tests.
Certificate Effective Date 11/6/2023
Certificate Expiration Date 11/5/2025
Facility Type Physician Office
Lab Director DR. ENRIQUE OVIEDO

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