21D2180930 CLIA NUMBER - NEW ERA WELLNESS, LLC

Laboratory Demographics

  • CLIA Code: 21D2180930
  • Facility Name: NEW ERA WELLNESS, LLC
  • Facility Address: 5411 OLD FREDERICK ROAD SUITE 2
    BALTIMORE, MD
    ZIP 21229
  • Facility Phone: 410 775-6394
  • Facility Type: Practitioner Other
  • Facility Type: Waiver
  • Lab Director: MYTIS AGEN-DAVIS
  • NPI Number: 1528419561
  • Taxonomy: 363LF0000X - Nurse Practitioner

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CLIA Record

Field Name Field Value
CLIA Number 21D2180930
LAB Type Practitioner Other
Facility Name NEW ERA WELLNESS, LLC
Street 5411 OLD FREDERICK ROAD SUITE 2
City BALTIMORE
State MD
ZIP 21229
Phone 410 775-6394
Certificate Type Certificate of Waiver
Certificate Type Description This certificate is issued to a laboratory to perform only waived tests.
Certificate Effective Date 3/24/2024
Certificate Expiration Date 3/23/2026
Facility Type Practitioner Other
Lab Director MYTIS AGEN-DAVIS

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