21D2247111 CLIA NUMBER - KELLY CARE

Laboratory Demographics

  • CLIA Code: 21D2247111
  • Facility Name: KELLY CARE
  • Facility Address: 6100 DAY LONG LANE SUITE 105
    CLARKSVILLE, MD
    ZIP 21029
  • Facility Phone: 202 684-7167
  • Facility Type: Physician Office
  • Facility Type: Waiver
  • Lab Director: KELLY A. GOODMAN
  • NPI Number: 1659852580
  • Taxonomy: 363LP2300X - Nurse Practitioner

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CLIA Record

Field Name Field Value
CLIA Number 21D2247111
LAB Type Physician Office
Facility Name KELLY CARE
Street 6100 DAY LONG LANE SUITE 105
City CLARKSVILLE
State MD
ZIP 21029
Phone 202 684-7167
Certificate Type Certificate of Waiver
Certificate Type Description This certificate is issued to a laboratory to perform only waived tests.
Certificate Effective Date 1/4/2024
Certificate Expiration Date 1/3/2026
Facility Type Physician Office
Lab Director KELLY A. GOODMAN

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