22D0077581 CLIA NUMBER - VASANT THACKER MD

Laboratory Demographics

  • CLIA Code: 22D0077581
  • Facility Name: VASANT THACKER MD
  • Facility Address: 101 MAIN ST #210
    MEDFORD, MA
    ZIP 02155
  • Facility Phone: 617 396-8100
  • Facility Type: Physician Office
  • Facility Type: Microscopy
  • Lab Director: VASANT M. THACKER
  • NPI Number: 1679611461
  • Taxonomy: 207V00000X - Obstetrics & Gynecology

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CLIA Record

Field Name Field Value
CLIA Number 22D0077581
LAB Type Physician Office
Facility Name VASANT THACKER MD
Street 101 MAIN ST #210
City MEDFORD
State MA
ZIP 02155
Phone 617 396-8100
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 9/1/2024
Certificate Expiration Date 8/31/2026
Facility Type Physician Office
Lab Director VASANT M. THACKER

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