21D2203034 CLIA NUMBER - PASSPORT HEALTH/ LAWRENCE NOBLE ENTERPRISES, INC

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Laboratory Demographics

CLIA Number: 21D2203034

Facility Name: PASSPORT HEALTH/ LAWRENCE NOBLE ENTERPRISES, INC

Facility Address:
1734 ELTON RD SUITE 205
SILVER SPRING, MD
ZIP 20903
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Facility Phone Number: 301 408-4544

Facility Type: Physician Office

Certificate Type: Waiver

NPI Number: 1841686490

Taxonomy: 261QH0100X - Clinic/Center

CLIA Record

Field Name	Field Value
CLIA Number	21D2203034
LAB Type	Physician Office
Facility Name	PASSPORT HEALTH/ LAWRENCE NOBLE ENTERPRISES, INC
Street	1734 ELTON RD SUITE 205
City	SILVER SPRING
State	MD
ZIP	20903
Phone	301 408-4544
CertificateType	4
CertificateEffectiveDate	12/2/2022
CertificateExpirationDate	12/1/2024
FacilityType	Waiver

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