21D2308143 CLIA NUMBER - CAPITAL CENTER FOR FUNCTIONAL MEDICINE LLC

Laboratory Demographics

  • CLIA Code: 21D2308143
  • Facility Name: CAPITAL CENTER FOR FUNCTIONAL MEDICINE LLC
  • Facility Address: 11325 SEVEN LOCKS RD SUITE 290
    POTOMAC, MD
    ZIP 20854
  • Facility Phone: 240 507-5110
  • Facility Type: Physician Office
  • Facility Type: Waiver
  • Lab Director: ANDREW WONG
  • NPI Number: 1922496462
  • Taxonomy: 207R00000X - Internal Medicine

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CLIA Record

Field Name Field Value
CLIA Number 21D2308143
LAB Type Physician Office
Facility Name CAPITAL CENTER FOR FUNCTIONAL MEDICINE LLC
Street 11325 SEVEN LOCKS RD SUITE 290
City POTOMAC
State MD
ZIP 20854
Phone 240 507-5110
Certificate Type Certificate of Waiver
Certificate Type Description This certificate is issued to a laboratory to perform only waived tests.
Certificate Effective Date 7/23/2024
Certificate Expiration Date 7/22/2026
Facility Type Physician Office
Lab Director ANDREW WONG

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