20D2154202 CLIA NUMBER - INTERMED PA

Laboratory Demographics

  • CLIA Code: 20D2154202
  • Facility Name: INTERMED PA
  • Facility Address: 100 FODEN ROAD EAST
    SOUTH PORTLAND, ME
    ZIP 04106
  • Facility Phone: 207 523-3687
  • Facility Type: Physician Office
  • Facility Type: Microscopy
  • Lab Director: DAN LOISELLE
  • NPI Number: 1033367982
  • Taxonomy: 291U00000X - Clinical Medical Laboratory

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CLIA Record

Field Name Field Value
CLIA Number 20D2154202
LAB Type Physician Office
Facility Name INTERMED PA
Street 100 FODEN ROAD EAST
City SOUTH PORTLAND
State ME
ZIP 04106
Phone 207 523-3687
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 9/7/2024
Certificate Expiration Date 9/6/2026
Facility Type Physician Office
Lab Director DAN LOISELLE

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