21D2295462 CLIA NUMBER - EASTERN SHORE PRIMARY CARE & WELLNESS

Laboratory Demographics

CLIA Number: 21D2295462

Facility Name: EASTERN SHORE PRIMARY CARE & WELLNESS

Facility Address:
1505 S SALISBURY BLVD
SALISBURY, MD
ZIP 21801
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Facility Phone Number: 410 936-5500

Facility Type: Physician Office

Certificate Type: Waiver

NPI Number: 1285404699

Taxonomy: 363LF0000X - Nurse Practitioner

CLIA Record

Field Name	Field Value
CLIA Number	21D2295462
LAB Type	Physician Office
Facility Name	EASTERN SHORE PRIMARY CARE & WELLNESS
Street	1505 S SALISBURY BLVD
City	SALISBURY
State	MD
ZIP	21801
Phone	410 936-5500
CertificateType	4
CertificateEffectiveDate	12/12/2023
CertificateExpirationDate	12/11/2025
FacilityType	Waiver

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