21D2283320 CLIA NUMBER - ANTIETAM FAMILY HEALTH

Laboratory Demographics

CLIA Number: 21D2283320

Facility Name: ANTIETAM FAMILY HEALTH

Facility Address:
1101 OPAL CT #217
HAGERSTOWN, MD
ZIP 21740
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Facility Phone Number: 240 203-8864

Facility Type: Physician Office

Certificate Type: Waiver

NPI Number: 1548972318

Taxonomy: 363LF0000X - Nurse Practitioner

CLIA Record

Field Name	Field Value
CLIA Number	21D2283320
LAB Type	Physician Office
Facility Name	ANTIETAM FAMILY HEALTH
Street	1101 OPAL CT #217
City	HAGERSTOWN
State	MD
ZIP	21740
Phone	240 203-8864
CertificateType	4
CertificateEffectiveDate	6/6/2023
CertificateExpirationDate	6/5/2025
FacilityType	Waiver

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