21D2159075 CLIA NUMBER - MAFOT & ASSOCIATES MEDICAL SERVICES

Laboratory Demographics

  • CLIA Code: 21D2159075
  • Facility Name: MAFOT & ASSOCIATES MEDICAL SERVICES
  • Facility Address: 1403 MADISON PARK DRIVE SUITE 200
    GLEN BURNIE, MD
    ZIP 21061
  • Facility Phone: (410) 487-6902
  • Facility Type: Physician Office
  • Facility Type: Waiver
  • Lab Director: DAGOBERT SIMO MD
  • NPI Number: 1104248541
  • Taxonomy: 208D00000X - General Practice

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CLIA Record

Field Name Field Value
CLIA Number 21D2159075
LAB Type Physician Office
Facility Name MAFOT & ASSOCIATES MEDICAL SERVICES
Street 1403 MADISON PARK DRIVE SUITE 200
City GLEN BURNIE
State MD
ZIP 21061
Phone 4104876902
Certificate Type Certificate of Waiver
Certificate Type Description This certificate is issued to a laboratory to perform only waived tests.
Certificate Effective Date 12/12/2024
Certificate Expiration Date 12/11/2026
Facility Type Physician Office
Lab Director DAGOBERT SIMO MD

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This page was last updated on: 5/18/2026