21D2278829 CLIA NUMBER - LIFEBRIDGE HEALTH COMMUNITY HEALTH AND WELLNESS

Laboratory Demographics

  • CLIA Code: 21D2278829
  • Facility Name: LIFEBRIDGE HEALTH COMMUNITY HEALTH AND WELLNESS
  • Facility Address: 2401 W BELVEDERE AVENUE
    BALTIMORE, MD
    ZIP 21215
  • Facility Phone: 410 521-7973
  • Facility Type: Other - MOBILE HEALTH FAIR
  • Facility Type: Waiver
  • Lab Director: DR. CHAITANYA RAVI
  • NPI Number: 1174856645
  • Taxonomy: 152W00000X - Optometrist

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CLIA Record

Field Name Field Value
CLIA Number 21D2278829
LAB Type Other - MOBILE HEALTH FAIR
Facility Name LIFEBRIDGE HEALTH COMMUNITY HEALTH AND WELLNESS
Street 2401 W BELVEDERE AVENUE
City BALTIMORE
State MD
ZIP 21215
Phone 410 521-7973
Certificate Type Certificate of Waiver
Certificate Type Description This certificate is issued to a laboratory to perform only waived tests.
Certificate Effective Date 3/24/2025
Certificate Expiration Date 3/23/2027
Facility Type Other - MOBILE HEALTH FAIR
Lab Director DR. CHAITANYA RAVI

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