21D2281566 CLIA NUMBER - MEDICAL PRACTICES OF ANTIETAM LLC DBA

Laboratory Demographics

CLIA Number: 21D2281566

Facility Name: MEDICAL PRACTICES OF ANTIETAM LLC DBA

Facility Address:
11110 MEDICAL CAMPUSRD SUITE 229
HAGERSTOWN, MD
ZIP 21742
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Facility Phone Number: 301 790-8073

Facility Type: Physician Office

Certificate Type: Accreditation

NPI Number: 1518686229

Taxonomy: 261QA1903X - Clinic/Center

CLIA Record

Field Name	Field Value
CLIA Number	21D2281566
LAB Type	Physician Office
Facility Name	MEDICAL PRACTICES OF ANTIETAM LLC DBA
Street	11110 MEDICAL CAMPUSRD SUITE 229
City	HAGERSTOWN
State	MD
ZIP	21742
Phone	301 790-8073
CertificateType	1
CertificateEffectiveDate	5/9/2023
CertificateExpirationDate	5/8/2025
FacilityType	Accreditation

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