07D1057164 CLIA NUMBER - SEAPORT DERMATOLOGY MOHS SURGERY CENTER

Laboratory Demographics

  • CLIA Code: 07D1057164
  • Facility Name: SEAPORT DERMATOLOGY MOHS SURGERY CENTER
  • Facility Address: 34 WATER ST SUITE # 2
    MYSTIC, CT
    ZIP 06355
  • Facility Phone: 860 572-9994
  • Facility Type: Physician Office
  • Facility Type: Certificate of Compliance
  • Lab Director: JOHN R. WEST MD
  • NPI Number: 1376575324
  • Taxonomy: 207ND0101X - Dermatology

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CLIA Record

Field Name Field Value
CLIA Number 07D1057164
LAB Type Physician Office
Facility Name SEAPORT DERMATOLOGY MOHS SURGERY CENTER
Street 34 WATER ST SUITE # 2
City MYSTIC
State CT
ZIP 06355
Phone 860 572-9994
Certificate Type Certificate of Compliance
Certificate Type Description This certificate is issued to a laboratory after an inspection that finds the laboratory to be in compliance with all applicable CLIA requirements.
Certificate Effective Date 3/2/2025
Certificate Expiration Date 3/1/2027
Facility Type Physician Office
Lab Director JOHN R. WEST MD

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