20D2156912 CLIA NUMBER - PORTLAND DIRECT PRIMARY CARE

Laboratory Demographics

  • CLIA Code: 20D2156912
  • Facility Name: PORTLAND DIRECT PRIMARY CARE
  • Facility Address: 27 OCEAN ST SUITE 3
    SOUTH PORTLAND, ME
    ZIP 04106
  • Facility Phone: 207 618-9792
  • Facility Type: Physician Office
  • Facility Type: Microscopy
  • Lab Director: OREN L. GERSTEN
  • NPI Number: 1164966529
  • Taxonomy: 235Z00000X - Speech-Language Pathologist

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CLIA Record

Field Name Field Value
CLIA Number 20D2156912
LAB Type Physician Office
Facility Name PORTLAND DIRECT PRIMARY CARE
Street 27 OCEAN ST SUITE 3
City SOUTH PORTLAND
State ME
ZIP 04106
Phone 207 618-9792
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 10/26/2024
Certificate Expiration Date 10/25/2026
Facility Type Physician Office
Lab Director OREN L. GERSTEN

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