21D2143493 CLIA NUMBER - MATCLINIC PHYSICIANS PRACTICE GROUP LLC

Laboratory Demographics

  • CLIA Code: 21D2143493
  • Facility Name: MATCLINIC PHYSICIANS PRACTICE GROUP LLC
  • Facility Address: 601 7TH STREET SUITE 304
    LAUREL, MD
    ZIP 20707
  • Facility Phone: 410 302-1296
  • Facility Type: Physician Office
  • Facility Type: Waiver
  • Lab Director: ENRIQUE I. OVIEDO
  • NPI Number: 1265084727
  • Taxonomy: 101YA0400X - Counselor

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CLIA Record

Field Name Field Value
CLIA Number 21D2143493
LAB Type Physician Office
Facility Name MATCLINIC PHYSICIANS PRACTICE GROUP LLC
Street 601 7TH STREET SUITE 304
City LAUREL
State MD
ZIP 20707
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 1/31/2024
Certificate Expiration Date 1/30/2026
Facility Type Physician Office
Lab Director ENRIQUE I. OVIEDO

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