21D2215285 CLIA NUMBER - MATCLINIC PHYSICIAN PRACTICE GROUP LLC

Laboratory Demographics

  • CLIA Code: 21D2215285
  • Facility Name: MATCLINIC PHYSICIAN PRACTICE GROUP LLC
  • Facility Address: 253 LEWIS LANE STE 201
    HAVRE DE GRACE, MD
    ZIP 21078
  • Facility Phone: 410 302-1296
  • Facility Type: Physician Office
  • Facility Type: Waiver
  • Lab Director: DR. ENRIQUE I. OVIEDO
  • NPI Number: 1083204424
  • Taxonomy: 261QM0801X - Clinic/Center

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CLIA Record

Field Name Field Value
CLIA Number 21D2215285
LAB Type Physician Office
Facility Name MATCLINIC PHYSICIAN PRACTICE GROUP LLC
Street 253 LEWIS LANE STE 201
City HAVRE DE GRACE
State MD
ZIP 21078
Phone 410 302-1296
Certificate Type Certificate of Waiver
Certificate Type Description This certificate is issued to a laboratory to perform only waived tests.
Certificate Effective Date 3/2/2025
Certificate Expiration Date 3/1/2027
Facility Type Physician Office
Lab Director DR. ENRIQUE I. OVIEDO

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