49D2185833 CLIA NUMBER - PATRONUS MEDICAL, LLC

Laboratory Demographics

CLIA Number: 49D2185833

Facility Name: PATRONUS MEDICAL, LLC

Facility Address:
8300 BOONE BLVD, STE 500
VIENNA, VA
ZIP 22182
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Facility Phone Number: 866 870-1877

Facility Type: Physician Office

Certificate Type: Waiver

NPI Number: 1851830178

Taxonomy: 208D00000X - General Practice
A physician who specializes in the general practice of diagnosing, treating, and managing patients with a variety of illnesses and conditions. Source: National Uniform Claim Committee

CLIA Record

Field Name	Field Value
CLIA Number	49D2185833
LAB Type	Physician Office
Facility Name	PATRONUS MEDICAL, LLC
Street	8300 BOONE BLVD, STE 500
City	VIENNA
State	VA
ZIP	22182
Phone	866 870-1877
CertificateType	4
CertificateEffectiveDate	6/10/2022
CertificateExpirationDate	6/9/2024
FacilityType	Waiver

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This page was last updated on: 4/23/2024