21D2290002 CLIA NUMBER - MEDHAVEN HEALTH

Laboratory Demographics

  • CLIA Code: 21D2290002
  • Facility Name: MEDHAVEN HEALTH
  • Facility Address: 7310 RITCHIE HWY #519
    GLEN BURNIE, MD
    ZIP 21061
  • Facility Phone: 301 501-5779
  • Facility Type: Physician Office
  • Facility Type: Waiver
  • Lab Director: OLUWAKEMI F. BALOGUN
  • NPI Number: 1710618152
  • Taxonomy: 261QH0100X - Clinic/Center

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CLIA Record

Field Name Field Value
CLIA Number 21D2290002
LAB Type Physician Office
Facility Name MEDHAVEN HEALTH
Street 7310 RITCHIE HWY #519
City GLEN BURNIE
State MD
ZIP 21061
Phone 301 501-5779
Certificate Type Certificate of Waiver
Certificate Type Description This certificate is issued to a laboratory to perform only waived tests.
Certificate Effective Date 9/19/2025
Certificate Expiration Date 9/18/2027
Facility Type Physician Office
Lab Director OLUWAKEMI F. BALOGUN

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