21D2231420 CLIA NUMBER - MATCLINIC PHYSICIAN PRACTICE GROUP LLC

Laboratory Demographics

  • CLIA Code: 21D2231420
  • Facility Name: MATCLINIC PHYSICIAN PRACTICE GROUP LLC
  • Facility Address: 1101 OPAL COURT
    HAGERSTOWN, MD
    ZIP 21740
  • Facility Phone: 443 904-6285
  • Facility Type: Physician Office
  • Facility Type: Waiver
  • Lab Director: DR. ENRIQUE J. OVIEDO
  • NPI Number: 1598335671
  • Taxonomy: 207RA0401X - Internal Medicine

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CLIA Record

Field Name Field Value
CLIA Number 21D2231420
LAB Type Physician Office
Facility Name MATCLINIC PHYSICIAN PRACTICE GROUP LLC
Street 1101 OPAL COURT
City HAGERSTOWN
State MD
ZIP 21740
Phone 443 904-6285
Certificate Type Certificate of Waiver
Certificate Type Description This certificate is issued to a laboratory to perform only waived tests.
Certificate Effective Date 8/3/2025
Certificate Expiration Date 8/2/2027
Facility Type Physician Office
Lab Director DR. ENRIQUE J. OVIEDO

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