CLIA lab
CLIA 49D2280070: Blue Mantle Medicine, PLLC
Fairfax, VA. Certificate and address details from the CMS Provider of Services file for clinical laboratories.
CLIA number 49D2280070 belongs to Blue Mantle Medicine, PLLC in Fairfax, VA.
Certificate of Waiver, effective April 12, 2025, expires April 11, 2027.
Active in the CMS Provider of Services file posted October 16, 2026.
Source: CMS Provider of Services File, Clinical Laboratories (CLIA), as of October 16, 2026. Publisher page
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Certificate
- Certificate type
- Certificate of Waiver
- Certificate effective
- April 12, 2025
- Certificate expiration
- April 11, 2027
- Status in the CMS file
- Active (termination code 00)
- Original participation date
- April 12, 2023
- Facility type
- Physician office
- Ownership (control type)
- Proprietary
- Lab classification
- CLIA laboratory
Source: CMS Provider of Services File, Clinical Laboratories (CLIA), as of October 16, 2026. Publisher page
Lab and contact
- CLIA number
- 49D2280070
- Lab name
- Blue Mantle Medicine, PLLC
- Address
- 4001 Fair Ridge Dr, Suite #305, Fairfax, VA 22033
- Phone
- (540) 645-1856
- Fax
- (703) 520-9880
Annual test volume the lab reported
- Waived tests
- 100
Volumes are what the lab reported to CMS on its CMS-116 application, as carried in the file.
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Related
Questions
What is the CLIA number for Blue Mantle Medicine, PLLC in Fairfax?
49D2280070, per the CMS Provider of Services file posted October 16, 2026.
What CLIA certificate does Blue Mantle Medicine, PLLC hold?
A Certificate of Waiver, according to the CMS file.
When does CLIA 49D2280070 expire?
The CMS file lists April 11, 2027 as the certificate expiration date; the certificate took effect April 12, 2025.