21D2185425 CLIA NUMBER - BAYSIDE PEDIATRICS - FULTON LLC

Laboratory Demographics

  • CLIA Code: 21D2185425
  • Facility Name: BAYSIDE PEDIATRICS - FULTON LLC
  • Facility Address: 7625 MAPLE LAWN BLVD #145
    FULTON, MD
    ZIP 20759
  • Facility Phone: 410 224-7667
  • Facility Type: Prison
  • Facility Type: Waiver
  • Lab Director: DR. JEFFREY T. NOLD
  • NPI Number: 1881215994
  • Taxonomy: 208000000X - Pediatrics

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CLIA Record

Field Name Field Value
CLIA Number 21D2185425
LAB Type Prison
Facility Name BAYSIDE PEDIATRICS - FULTON LLC
Street 7625 MAPLE LAWN BLVD #145
City FULTON
State MD
ZIP 20759
Phone 410 224-7667
Certificate Type Certificate of Waiver
Certificate Type Description This certificate is issued to a laboratory to perform only waived tests.
Certificate Effective Date 6/3/2024
Certificate Expiration Date 6/2/2026
Facility Type Prison
Lab Director DR. JEFFREY T. NOLD

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