22D0077316 CLIA NUMBER - COMMONWEALTH PRIMARY CARE, INC

Laboratory Demographics

  • CLIA Code: 22D0077316
  • Facility Name: COMMONWEALTH PRIMARY CARE, INC
  • Facility Address: 365 MAIN STREET
    WINTHROP, MA
    ZIP 02152
  • Facility Phone: 617 846-5352
  • Facility Type: Practitioner Other
  • Facility Type: Waiver
  • Lab Director: MS. JEANNE HOLGERSEN
  • NPI Number: 1417723263
  • Taxonomy: 261QP2300X - Clinic/Center

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CLIA Record

Field Name Field Value
CLIA Number 22D0077316
LAB Type Practitioner Other
Facility Name COMMONWEALTH PRIMARY CARE, INC
Street 365 MAIN STREET
City WINTHROP
State MA
ZIP 02152
Phone 617 846-5352
Certificate Type Certificate of Waiver
Certificate Type Description This certificate is issued to a laboratory to perform only waived tests.
Certificate Effective Date 1/24/2024
Certificate Expiration Date 1/23/2026
Facility Type Practitioner Other
Lab Director MS. JEANNE HOLGERSEN

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