20D0088755 CLIA NUMBER - INTERMED PA

Laboratory Demographics

  • CLIA Code: 20D0088755
  • Facility Name: INTERMED PA
  • Facility Address: 50 FODEN ROAD
    SOUTH PORTLAND, ME
    ZIP 04106
  • Facility Phone: 207 523-3687
  • Facility Type: Independent
  • Facility Type: Accreditation
  • Lab Director: DR. HAROLD KISNER
  • NPI Number: 1336538198
  • Taxonomy: 207R00000X - Internal Medicine

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CLIA Record

Field Name Field Value
CLIA Number 20D0088755
LAB Type Independent
Facility Name INTERMED PA
Street 50 FODEN ROAD
City SOUTH PORTLAND
State ME
ZIP 04106
Phone 207 523-3687
Certificate Type Certificate of Accreditation
Certificate Type Description This is a certificate that is issued to a laboratory on the basis of the laboratory's accreditation by an accreditation organization approved by CMS.
Certificate Effective Date 12/23/2023
Certificate Expiration Date 12/22/2025
Facility Type Independent
Lab Director DR. HAROLD KISNER

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