19D1031497 CLIA NUMBER - MARTHA E STEWART MD LLC

Laboratory Demographics

  • CLIA Code: 19D1031497
  • Facility Name: MARTHA E STEWART MD LLC
  • Facility Address: 4060 LONESOME ROAD
    MANDEVILLE, LA
    ZIP 70448
  • Facility Phone: 985 727-7701
  • Facility Type: Physician Office
  • Facility Type: Microscopy
  • Lab Director: MARTHA E. STEWART MD
  • NPI Number: 1972535284
  • Taxonomy: 207N00000X - Dermatology

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CLIA Record

Field Name Field Value
CLIA Number 19D1031497
LAB Type Physician Office
Facility Name MARTHA E STEWART MD LLC
Street 4060 LONESOME ROAD
City MANDEVILLE
State LA
ZIP 70448
Phone 985 727-7701
Certificate Type Certificate for Provider-Performed Microscopy Procedures (PPMP)
Certificate Type Description This certificate is issued to a laboratory in which a physician, midlevel practitioner or dentist performs no tests other than the microscopy procedures. This certificate permits the laboratory to also perform waived tests.
Certificate Effective Date 10/1/2024
Certificate Expiration Date 9/30/2026
Facility Type Physician Office
Lab Director MARTHA E. STEWART MD

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