20D1104364 CLIA NUMBER - NORTHERN LIGHT BLUE HILL PROVIDER PRACTICES

Laboratory Demographics

  • CLIA Code: 20D1104364
  • Facility Name: NORTHERN LIGHT BLUE HILL PROVIDER PRACTICES
  • Facility Address: 57 WATER ST, SUSSMAN BUILDING
    BLUE HILL, ME
    ZIP 04614
  • Facility Phone: 207 374-3400
  • Facility Type: Physician Office
  • Facility Type: Waiver
  • Lab Director: JOSEPH M. GAETANO
  • NPI Number: 1730779976
  • Taxonomy: 261QP2300X - Clinic/Center

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CLIA Record

Field Name Field Value
CLIA Number 20D1104364
LAB Type Physician Office
Facility Name NORTHERN LIGHT BLUE HILL PROVIDER PRACTICES
Street 57 WATER ST, SUSSMAN BUILDING
City BLUE HILL
State ME
ZIP 04614
Phone 207 374-3400
Certificate Type Certificate of Waiver
Certificate Type Description This certificate is issued to a laboratory to perform only waived tests.
Certificate Effective Date 11/15/2024
Certificate Expiration Date 11/14/2026
Facility Type Physician Office
Lab Director JOSEPH M. GAETANO

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