07D0715861 CLIA NUMBER - STAMFORD PRIMARY CARE ATTN-MARY VOTA

Laboratory Demographics

CLIA Number: 07D0715861

Facility Name: STAMFORD PRIMARY CARE ATTN-MARY VOTA

Facility Address:
1275 SUMMER STREET SUITE 105
STAMFORD, CT
ZIP 06905
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Facility Phone Number: 203 325-2667

Facility Type: Physician Office

Certificate Type: Waiver

NPI Number: 1730393307

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	07D0715861
LAB Type	Physician Office
Facility Name	STAMFORD PRIMARY CARE ATTN-MARY VOTA
Street	1275 SUMMER STREET SUITE 105
City	STAMFORD
State	CT
ZIP	06905
Phone	203 325-2667
CertificateType	4
CertificateEffectiveDate	9/1/2022
CertificateExpirationDate	8/31/2024
FacilityType	Waiver

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