21D2258003 CLIA NUMBER - FIRSTCHOICE PRIMARY CARE

Laboratory Demographics

CLIA Number: 21D2258003

Facility Name: FIRSTCHOICE PRIMARY CARE

Facility Address:
9841 WASHINGTONIAN BLVD #200
GAITHERSBURG, MD
ZIP 20878
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Facility Phone Number: 240 720-7797

Facility Type: Practitioner Other

Certificate Type: Waiver

NPI Number: 1376203133

Taxonomy: 261QM1300X - Clinic/Center

CLIA Record

Field Name	Field Value
CLIA Number	21D2258003
LAB Type	Practitioner Other
Facility Name	FIRSTCHOICE PRIMARY CARE
Street	9841 WASHINGTONIAN BLVD #200
City	GAITHERSBURG
State	MD
ZIP	20878
Phone	240 720-7797
CertificateType	4
CertificateEffectiveDate	4/14/2024
CertificateExpirationDate	4/13/2026
FacilityType	Waiver

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This page was last updated on: 4/23/2024