21D2141727 CLIA NUMBER - SHORE WELLNESS AND MEDSPA

Laboratory Demographics

  • CLIA Code: 21D2141727
  • Facility Name: SHORE WELLNESS AND MEDSPA
  • Facility Address: 11200 RACETRACK ROAD BLDG 6 UNIT A104
    BERLIN, MD
    ZIP 21811
  • Facility Phone: 410 973-1030
  • Facility Type: Physician Office
  • Facility Type: Waiver
  • Lab Director: WILLIAM E. GUNN MD
  • NPI Number: 1104445535
  • Taxonomy: 261QP2300X - Clinic/Center

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CLIA Record

Field Name Field Value
CLIA Number 21D2141727
LAB Type Physician Office
Facility Name SHORE WELLNESS AND MEDSPA
Street 11200 RACETRACK ROAD BLDG 6 UNIT A104
City BERLIN
State MD
ZIP 21811
Phone 410 973-1030
Certificate Type Certificate of Waiver
Certificate Type Description This certificate is issued to a laboratory to perform only waived tests.
Certificate Effective Date 12/20/2023
Certificate Expiration Date 12/19/2025
Facility Type Physician Office
Lab Director WILLIAM E. GUNN MD

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