21D2165389 CLIA NUMBER - MATCLINIC PHYSICIANS PRACTICE GROUP, LLC

Laboratory Demographics

  • CLIA Code: 21D2165389
  • Facility Name: MATCLINIC PHYSICIANS PRACTICE GROUP, LLC
  • Facility Address: 107 RIDGELY AVENUE SUITE 12
    ANNAPOLIS, MD
    ZIP 21401
  • Facility Phone: 410 302-1296
  • Facility Type: Physician Office
  • Facility Type: Waiver
  • Lab Director: ENRIQUE I. OVIEDO
  • NPI Number: 1174175632
  • Taxonomy: 101YA0400X - Counselor

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CLIA Record

Field Name Field Value
CLIA Number 21D2165389
LAB Type Physician Office
Facility Name MATCLINIC PHYSICIANS PRACTICE GROUP, LLC
Street 107 RIDGELY AVENUE SUITE 12
City ANNAPOLIS
State MD
ZIP 21401
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 4/26/2025
Certificate Expiration Date 4/25/2027
Facility Type Physician Office
Lab Director ENRIQUE I. OVIEDO

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