21D2312566 CLIA NUMBER - DERM-360

Laboratory Demographics

  • CLIA Code: 21D2312566
  • Facility Name: DERM-360
  • Facility Address: 319 E ANTIETAM STREET
    HAGERSTOWN, MD
    ZIP 21740
  • Facility Phone: 540 560-3969
  • Facility Type: Physician Office
  • Facility Type: Microscopy
  • Lab Director: DR. BHARATH BALU
  • NPI Number: 1497581821
  • Taxonomy: 207N00000X - Dermatology

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CLIA Record

Field Name Field Value
CLIA Number 21D2312566
LAB Type Physician Office
Facility Name DERM-360
Street 319 E ANTIETAM STREET
City HAGERSTOWN
State MD
ZIP 21740
Phone 540 560-3969
Certificate Type Certificate for Provider-Performed Microscopy Procedures (PPMP)
Certificate Type Description This certificate is issued to a laboratory in which a physician, midlevel practitioner or dentist performs no tests other than the microscopy procedures. This certificate permits the laboratory to also perform waived tests.
Certificate Effective Date 10/15/2024
Certificate Expiration Date 10/14/2026
Facility Type Physician Office
Lab Director DR. BHARATH BALU

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