20D2208190 CLIA NUMBER - MEDICAL LASER SERVICES, LLC

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Laboratory Demographics

CLIA Number: 20D2208190

Facility Name: MEDICAL LASER SERVICES, LLC

Facility Address:
1945 CONGRESS ST
PORTLAND, ME
ZIP 04102
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Facility Phone Number: 207 761-0177

Facility Type: Physician Office

Certificate Type: Waiver

NPI Number: 1669589669

Taxonomy: 174400000X - Specialist
An individual educated and trained in an applied knowledge discipline used in the performance of work at a level requiring knowledge and skills beyond or apart from that provided by a general education or liberal arts degree.

CLIA Record

Field Name	Field Value
CLIA Number	20D2208190
LAB Type	Physician Office
Facility Name	MEDICAL LASER SERVICES, LLC
Street	1945 CONGRESS ST
City	PORTLAND
State	ME
ZIP	04102
Phone	207 761-0177
CertificateType	4
CertificateEffectiveDate	1/5/2023
CertificateExpirationDate	1/4/2025
FacilityType	Waiver

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This page was last updated on: 4/23/2024