21D2176525 CLIA NUMBER - EXCEPTIONAL PRIMARY & PREVENTIVE HEALTH CARE

Laboratory Demographics

CLIA Number: 21D2176525

Facility Name: EXCEPTIONAL PRIMARY & PREVENTIVE HEALTH CARE

Facility Address:
10301 GEORGIA AVENUE #209
SILVER SPRING, MD
ZIP 20902
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Facility Phone Number: 240 641-4944

Facility Type: Physician Office

Certificate Type: Microscopy

NPI Number: 1336700251

Taxonomy: 363LF0000X - Nurse Practitioner

CLIA Record

Field Name	Field Value
CLIA Number	21D2176525
LAB Type	Physician Office
Facility Name	EXCEPTIONAL PRIMARY & PREVENTIVE HEALTH CARE
Street	10301 GEORGIA AVENUE #209
City	SILVER SPRING
State	MD
ZIP	20902
Phone	240 641-4944
CertificateType	3
CertificateEffectiveDate	12/17/2023
CertificateExpirationDate	12/16/2025
FacilityType	PPMP

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