21D2257291 CLIA NUMBER - IVYMOUNT CLINIC LLC

Laboratory Demographics

  • CLIA Code: 21D2257291
  • Facility Name: IVYMOUNT CLINIC LLC
  • Facility Address: 6309 IVYMOUNT RD ARNP
    BALTIMORE, MD
    ZIP 21209
  • Facility Phone: 410 746-2126
  • Facility Type: Community Clinic
  • Facility Type: Waiver
  • Lab Director: RENEE HOCHMAN
  • NPI Number: 1740060730
  • Taxonomy: 363LF0000X - Nurse Practitioner

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CLIA Record

Field Name Field Value
CLIA Number 21D2257291
LAB Type Community Clinic
Facility Name IVYMOUNT CLINIC LLC
Street 6309 IVYMOUNT RD ARNP
City BALTIMORE
State MD
ZIP 21209
Phone 410 746-2126
Certificate Type Certificate of Waiver
Certificate Type Description This certificate is issued to a laboratory to perform only waived tests.
Certificate Effective Date 4/3/2024
Certificate Expiration Date 4/2/2026
Facility Type Community Clinic
Lab Director RENEE HOCHMAN

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