21D2165405 CLIA NUMBER - JASSI PRIMARY CARE PA

Laboratory Demographics

  • CLIA Code: 21D2165405
  • Facility Name: JASSI PRIMARY CARE PA
  • Facility Address: 325 HOSPITAL DR SUITE 205
    GLEN BURNIE, MD
    ZIP 21061
  • Facility Phone: 443 410-3161
  • Facility Type: Physician Office
  • Facility Type: Waiver
  • Lab Director: SUKHPAL JASSI
  • NPI Number: 1306310073
  • Taxonomy: 207R00000X - Internal Medicine

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CLIA Record

Field Name Field Value
CLIA Number 21D2165405
LAB Type Physician Office
Facility Name JASSI PRIMARY CARE PA
Street 325 HOSPITAL DR SUITE 205
City GLEN BURNIE
State MD
ZIP 21061
Phone 443 410-3161
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 SUKHPAL JASSI

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