20D2001054 CLIA NUMBER - GORHAM PRIMARY CARE, PC

Laboratory Demographics

  • CLIA Code: 20D2001054
  • Facility Name: GORHAM PRIMARY CARE, PC
  • Facility Address: 130 MAIN STREET
    GORHAM, ME
    ZIP 04038
  • Facility Phone: 207 839-5551
  • Facility Type: Physician Office
  • Facility Type: Microscopy
  • Lab Director: ANDREW NICHOLSON MD
  • NPI Number: 1851558399
  • Taxonomy: 207Q00000X - Family Medicine

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CLIA Record

Field Name Field Value
CLIA Number 20D2001054
LAB Type Physician Office
Facility Name GORHAM PRIMARY CARE, PC
Street 130 MAIN STREET
City GORHAM
State ME
ZIP 04038
Phone 207 839-5551
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 12/11/2023
Certificate Expiration Date 12/10/2025
Facility Type Physician Office
Lab Director ANDREW NICHOLSON MD

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