20D1053553 CLIA NUMBER - MAINE HEALTH - MAINE MEDICAL CENTER PORTLAND

Laboratory Demographics

  • CLIA Code: 20D1053553
  • Facility Name: MAINE HEALTH - MAINE MEDICAL CENTER PORTLAND
  • Facility Address: 22 BRAMHALL STREET
    PORTLAND, ME
    ZIP 04102
  • Facility Phone: 207 662-4014
  • Facility Type: Hospital
  • Facility Type: Waiver
  • Lab Director: TAREK HAMMOUR
  • NPI Number: 1710297494
  • Taxonomy: 208800000X - Urology

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CLIA Record

Field Name Field Value
CLIA Number 20D1053553
LAB Type Hospital
Facility Name MAINE HEALTH - MAINE MEDICAL CENTER PORTLAND
Street 22 BRAMHALL STREET
City PORTLAND
State ME
ZIP 04102
Phone 207 662-4014
Certificate Type Certificate of Waiver
Certificate Type Description This certificate is issued to a laboratory to perform only waived tests.
Certificate Effective Date 4/27/2024
Certificate Expiration Date 4/26/2026
Facility Type Hospital
Lab Director TAREK HAMMOUR

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