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21D2144898 CLIA NUMBER - CALVERT D D ASSOC ENDO AND SURG CTR LLC

Laboratory Demographics

CLIA Number: 21D2144898

Facility Name: CALVERT D D ASSOC ENDO AND SURG CTR LLC

Facility Address:
985 PRINCE FREDERICK BOULEVARD SUITE 104
PRINCE FREDERICK, MD
ZIP 20678
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Facility Phone Number: 410 414-5309

Facility Type: Ambulatory Surgery Center

Certificate Type: Waiver
NPI Number: 1699219766

Taxonomy: 261QE0800X - Clinic/Center

CLIA Record

Field Name Field Value
CLIA Number 21D2144898
LAB Type Ambulatory Surgery Center
Facility Name CALVERT D D ASSOC ENDO AND SURG CTR LLC
Street 985 PRINCE FREDERICK BOULEVARD SUITE 104
City PRINCE FREDERICK
State MD
ZIP 20678
Phone 410 414-5309
CertificateType 4
CertificateEffectiveDate 2/26/2024
CertificateExpirationDate 2/25/2026
FacilityType Waiver

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This page was last updated on: 4/23/2024