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20D0088564 CLIA NUMBER - MMP - PORTLAND PEDIATRICS

Laboratory Demographics

CLIA Number: 20D0088564

Facility Name: MMP - PORTLAND PEDIATRICS

Facility Address:
1577 CONGRESS STREET
PORTLAND, ME
ZIP 04102
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Facility Phone Number: 207 662-1442

Facility Type: Physician Office

Certificate Type: Waiver
NPI Number: 1619519873

Taxonomy: 207R00000X - Internal Medicine
A physician who provides long-term, comprehensive care in the office and the hospital, managing both common and complex illness of adolescents, adults and the elderly. Internists are trained in the diagnosis and treatment of cancer, infections and diseases affecting the heart, blood, kidneys, joints and digestive, respiratory and vascular systems. They are also trained in the essentials of primary care internal medicine, which incorporates an understanding of disease prevention, wellness, substance abuse, mental health and effective treatment of common problems of the eyes, ears, skin, nervous system and reproductive organs.

CLIA Record

Field Name Field Value
CLIA Number 20D0088564
LAB Type Physician Office
Facility Name MMP - PORTLAND PEDIATRICS
Street 1577 CONGRESS STREET
City PORTLAND
State ME
ZIP 04102
Phone 207 662-1442
CertificateType 4
CertificateEffectiveDate 8/12/2022
CertificateExpirationDate 8/11/2024
FacilityType Waiver

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