21D2315616 CLIA NUMBER - MEDSTAR HEALTH BALTIMORE PREVENTIVE MEDICINE CTR

Laboratory Demographics

  • CLIA Code: 21D2315616
  • Facility Name: MEDSTAR HEALTH BALTIMORE PREVENTIVE MEDICINE CTR
  • Facility Address: 9106 PHILADELPHIA RD #304
    BALTIMORE, MD
    ZIP 21237
  • Facility Phone: 410 238-3262
  • Facility Type: Physician Office
  • Facility Type: Waiver
  • Lab Director: DR. HOWARD GOLDMAN
  • NPI Number: 1225413768
  • Taxonomy: 282N00000X - General Acute Care Hospital

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CLIA Record

Field Name Field Value
CLIA Number 21D2315616
LAB Type Physician Office
Facility Name MEDSTAR HEALTH BALTIMORE PREVENTIVE MEDICINE CTR
Street 9106 PHILADELPHIA RD #304
City BALTIMORE
State MD
ZIP 21237
Phone 410 238-3262
Certificate Type Certificate of Waiver
Certificate Type Description This certificate is issued to a laboratory to perform only waived tests.
Certificate Effective Date 12/17/2024
Certificate Expiration Date 12/16/2026
Facility Type Physician Office
Lab Director DR. HOWARD GOLDMAN

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