21D2215288 CLIA NUMBER - CANNAKUSH CONSULTING OFFICE LLC

Laboratory Demographics

  • CLIA Code: 21D2215288
  • Facility Name: CANNAKUSH CONSULTING OFFICE LLC
  • Facility Address: 5411 OLD FREDERICK RD #18
    BALTIMORE, MD
    ZIP 21229
  • Facility Phone: 443 769-8368
  • Facility Type: Physician Office
  • Facility Type: Waiver
  • Lab Director: BETSY L. MOORE
  • NPI Number: 1215528369
  • Taxonomy: 261QP2300X - Clinic/Center

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CLIA Record

Field Name Field Value
CLIA Number 21D2215288
LAB Type Physician Office
Facility Name CANNAKUSH CONSULTING OFFICE LLC
Street 5411 OLD FREDERICK RD #18
City BALTIMORE
State MD
ZIP 21229
Phone 443 769-8368
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 BETSY L. MOORE

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