21D2143950 CLIA NUMBER - DEVINE FAMILY CARE PRACTICE LLC

Laboratory Demographics

  • CLIA Code: 21D2143950
  • Facility Name: DEVINE FAMILY CARE PRACTICE LLC
  • Facility Address: 7131 LIBERTY ROAD SUITE 100
    BALTIMORE, MD
    ZIP 21207
  • Facility Phone: 410 963-9577
  • Facility Type: Independent
  • Facility Type: Waiver
  • Lab Director: STELLA E. MBAH
  • NPI Number: 1053828244
  • Taxonomy: 207Q00000X - Family Medicine

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CLIA Record

Field Name Field Value
CLIA Number 21D2143950
LAB Type Independent
Facility Name DEVINE FAMILY CARE PRACTICE LLC
Street 7131 LIBERTY ROAD SUITE 100
City BALTIMORE
State MD
ZIP 21207
Phone 410 963-9577
Certificate Type Certificate of Waiver
Certificate Type Description This certificate is issued to a laboratory to perform only waived tests.
Certificate Effective Date 2/8/2024
Certificate Expiration Date 2/7/2026
Facility Type Independent
Lab Director STELLA E. MBAH

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