21D2208993 CLIA NUMBER - BELMONT FAMILY PRACTICE

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Laboratory Demographics

CLIA Number: 21D2208993

Facility Name: BELMONT FAMILY PRACTICE

Facility Address:
1346 BELMONT AVE SUITE 602
SALISBURY, MD
ZIP 21804
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Facility Phone Number: 443 978-7317

Facility Type: Physician Office

Certificate Type: Waiver

NPI Number: 1073063715

Taxonomy: 363LF0000X - Nurse Practitioner

CLIA Record

Field Name	Field Value
CLIA Number	21D2208993
LAB Type	Physician Office
Facility Name	BELMONT FAMILY PRACTICE
Street	1346 BELMONT AVE SUITE 602
City	SALISBURY
State	MD
ZIP	21804
Phone	443 978-7317
CertificateType	4
CertificateEffectiveDate	1/11/2023
CertificateExpirationDate	1/10/2025
FacilityType	Waiver

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