20D2110230 CLIA NUMBER - INTERMED MOHS LAB - DERMATOLOGY

Laboratory Demographics

  • CLIA Code: 20D2110230
  • Facility Name: INTERMED MOHS LAB - DERMATOLOGY
  • Facility Address: 100 FODEN RD, WEST SUITE 203
    SOUTH PORTLAND, ME
    ZIP 04106
  • Facility Phone: 207 523-3900
  • Facility Type: Physician Office
  • Facility Type: Certificate of Compliance
  • Lab Director: KENNETH J. GALECKAS
  • NPI Number: 1467422733
  • Taxonomy: 207R00000X - Internal Medicine

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CLIA Record

Field Name Field Value
CLIA Number 20D2110230
LAB Type Physician Office
Facility Name INTERMED MOHS LAB - DERMATOLOGY
Street 100 FODEN RD, WEST SUITE 203
City SOUTH PORTLAND
State ME
ZIP 04106
Phone 207 523-3900
Certificate Type Certificate of Compliance
Certificate Type Description This certificate is issued to a laboratory after an inspection that finds the laboratory to be in compliance with all applicable CLIA requirements.
Certificate Effective Date 8/11/2024
Certificate Expiration Date 8/10/2026
Facility Type Physician Office
Lab Director KENNETH J. GALECKAS

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