08D1091063 CLIA NUMBER - INCENDIUM, LLC

Laboratory Demographics

CLIA Number: 08D1091063

Facility Name: INCENDIUM, LLC

Facility Address:
1695 S STATE STREET, SUITE B
DOVER, DE
ZIP 19901
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Facility Phone Number: 302 465-7737

Facility Type: Independent

Certificate Type: Certificate of Compliance

NPI Number: 1912215542

Taxonomy: 2086S0122X - Surgery
A surgeon who specializes in plastic and reconstructive surgery.

CLIA Record

Field Name	Field Value
CLIA Number	08D1091063
LAB Type	Independent
Facility Name	INCENDIUM, LLC
Street	1695 S STATE STREET, SUITE B
City	DOVER
State	DE
ZIP	19901
Phone	302 465-7737
CertificateType	2
CertificateEffectiveDate	10/14/2023
CertificateExpirationDate	10/13/2025
FacilityType	Compliance

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