07D2205250 CLIA NUMBER - MODERN DERMATOLOGY PC

Laboratory Demographics

  • CLIA Code: 07D2205250
  • Facility Name: MODERN DERMATOLOGY PC
  • Facility Address: 1032 POST RD EAST
    WESTPORT, CT
    ZIP 06880
  • Facility Phone: 203 635-0770
  • Facility Type: Physician Office
  • Facility Type: Certificate of Compliance
  • Lab Director: SHAYAN CHRAGHLOU
  • NPI Number: 1497258719
  • Taxonomy: 207N00000X - Dermatology

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CLIA Record

Field Name Field Value
CLIA Number 07D2205250
LAB Type Physician Office
Facility Name MODERN DERMATOLOGY PC
Street 1032 POST RD EAST
City WESTPORT
State CT
ZIP 06880
Phone 203 635-0770
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 9/1/2025
Certificate Expiration Date 8/31/2027
Facility Type Physician Office
Lab Director SHAYAN CHRAGHLOU

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