49D2207798 CLIA NUMBER - AGELESS MD ARLINGTON PREVENTATIVE HEALTH & MEDICINE

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Laboratory Demographics

CLIA Number: 49D2207798

Facility Name: AGELESS MD ARLINGTON PREVENTATIVE HEALTH & MEDICINE

Facility Address:
2221 N BUCHANAN ST SUITE 102
ARLINGTON, VA
ZIP 22207
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Facility Phone Number: 703 688-2468

Facility Type: Physician Office

Certificate Type: Waiver

NPI Number: 1902153992

Taxonomy: 261Q00000X - Clinic/Center
A facility or distinct part of one used for the diagnosis and treatment of outpatients. Clinic/Center is irregularly defined, sometimes being limited to organizations serving specialized treatment requirements or distinct patient/client groups (e.g., radiology, poor, and public health).

CLIA Record

Field Name	Field Value
CLIA Number	49D2207798
LAB Type	Physician Office
Facility Name	AGELESS MD ARLINGTON PREVENTATIVE HEALTH & MEDICINE
Street	2221 N BUCHANAN ST SUITE 102
City	ARLINGTON
State	VA
ZIP	22207
Phone	703 688-2468
CertificateType	4
CertificateEffectiveDate	12/31/2022
CertificateExpirationDate	12/30/2024
FacilityType	Waiver

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