21D2276477 CLIA NUMBER - DIAGNOSTIC LAB OF SOUTHERN MARYLAND LLC

Laboratory Demographics

  • CLIA Code: 21D2276477
  • Facility Name: DIAGNOSTIC LAB OF SOUTHERN MARYLAND LLC
  • Facility Address: 3985 ST CHARLES PKWY STE 200E
    WALDORF, MD
    ZIP 20602
  • Facility Phone: 240 925-9449
  • Facility Type: Other - DIAGNOSTIC TESTING LAB
  • Facility Type: Waiver
  • Lab Director: TEMERIA WILCOX
  • NPI Number: 1366158719
  • Taxonomy: 261QH0100X - Clinic/Center

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CLIA Record

Field Name Field Value
CLIA Number 21D2276477
LAB Type Other - DIAGNOSTIC TESTING LAB
Facility Name DIAGNOSTIC LAB OF SOUTHERN MARYLAND LLC
Street 3985 ST CHARLES PKWY STE 200E
City WALDORF
State MD
ZIP 20602
Phone 240 925-9449
Certificate Type Certificate of Waiver
Certificate Type Description This certificate is issued to a laboratory to perform only waived tests.
Certificate Effective Date 2/9/2025
Certificate Expiration Date 2/8/2027
Facility Type Other - DIAGNOSTIC TESTING LAB
Lab Director TEMERIA WILCOX

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