21D2297105 CLIA NUMBER - CENTENNIAL MEDICAL GROUP

Laboratory Demographics

  • CLIA Code: 21D2297105
  • Facility Name: CENTENNIAL MEDICAL GROUP
  • Facility Address: 6250 OLD DOBBIN LANE
    COLUMBIA, MD
    ZIP 21045
  • Facility Phone: 410 730-3399
  • Facility Type: Physician Office
  • Facility Type: Waiver
  • Lab Director: RAJIV DUA
  • NPI Number: 1033858832
  • Taxonomy: 207Q00000X - Family Medicine

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CLIA Record

Field Name Field Value
CLIA Number 21D2297105
LAB Type Physician Office
Facility Name CENTENNIAL MEDICAL GROUP
Street 6250 OLD DOBBIN LANE
City COLUMBIA
State MD
ZIP 21045
Phone 410 730-3399
Certificate Type Certificate of Waiver
Certificate Type Description This certificate is issued to a laboratory to perform only waived tests.
Certificate Effective Date 1/10/2024
Certificate Expiration Date 1/9/2026
Facility Type Physician Office
Lab Director RAJIV DUA

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