07D0968602 CLIA NUMBER - MASHANTUCKET PEQUOT TRIBAL HEALTH DEPT

Laboratory Demographics

  • CLIA Code: 07D0968602
  • Facility Name: MASHANTUCKET PEQUOT TRIBAL HEALTH DEPT
  • Facility Address: 75 ROUTE 2
    LEDYARD, CT
    ZIP 06339
  • Facility Phone: 860 312-8000
  • Facility Type: Rural Health Clinic
  • Facility Type: Waiver
  • Lab Director: SETU VORA
  • NPI Number: 1508140922
  • Taxonomy: 207Q00000X - Family Medicine

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CLIA Record

Field Name Field Value
CLIA Number 07D0968602
LAB Type Rural Health Clinic
Facility Name MASHANTUCKET PEQUOT TRIBAL HEALTH DEPT
Street 75 ROUTE 2
City LEDYARD
State CT
ZIP 06339
Phone 860 312-8000
Certificate Type Certificate of Waiver
Certificate Type Description This certificate is issued to a laboratory to perform only waived tests.
Certificate Effective Date 12/16/2023
Certificate Expiration Date 12/15/2025
Facility Type Rural Health Clinic
Lab Director SETU VORA

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