21D2321224 CLIA NUMBER - GERIATRIC MULTISPECIALTY ASSOCIATES

Laboratory Demographics

  • CLIA Code: 21D2321224
  • Facility Name: GERIATRIC MULTISPECIALTY ASSOCIATES
  • Facility Address: 11350 PEMBROOKE SQ SUITE 311
    WALDORF, MD
    ZIP 20603
  • Facility Phone: 301 870-0660
  • Facility Type: Physician Office
  • Facility Type: Waiver
  • Lab Director: PHILIP WISOTSKY
  • NPI Number: 1316515372
  • Taxonomy: 207R00000X - Internal Medicine

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CLIA Record

Field Name Field Value
CLIA Number 21D2321224
LAB Type Physician Office
Facility Name GERIATRIC MULTISPECIALTY ASSOCIATES
Street 11350 PEMBROOKE SQ SUITE 311
City WALDORF
State MD
ZIP 20603
Phone 301 870-0660
Certificate Type Certificate of Waiver
Certificate Type Description This certificate is issued to a laboratory to perform only waived tests.
Certificate Effective Date 4/1/2025
Certificate Expiration Date 3/31/2027
Facility Type Physician Office
Lab Director PHILIP WISOTSKY

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