22D0078984 CLIA NUMBER - MYSTIC VALLEY UROLOGICAL ASSOCIATES

Laboratory Demographics

CLIA Number: 22D0078984

Facility Name: MYSTIC VALLEY UROLOGICAL ASSOCIATES

Facility Address:
800 WEST CUMMINGS PARK SUITE 6550
WOBURN, MA
ZIP 01801
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Facility Phone Number: 781 979-0661

Facility Type: Physician Office

Certificate Type: Waiver

NPI Number: 1740295575

Taxonomy: 208800000X - Urology
A urologist manages benign and malignant medical and surgical disorders of the genitourinary system and the adrenal gland. This specialist has comprehensive knowledge of and skills in endoscopic, percutaneous and open surgery of congenital and acquired conditions of the urinary and reproductive systems and their contiguous structures.

CLIA Record

Field Name	Field Value
CLIA Number	22D0078984
LAB Type	Physician Office
Facility Name	MYSTIC VALLEY UROLOGICAL ASSOCIATES
Street	800 WEST CUMMINGS PARK SUITE 6550
City	WOBURN
State	MA
ZIP	01801
Phone	781 979-0661
CertificateType	4
CertificateEffectiveDate	9/13/2023
CertificateExpirationDate	9/12/2025
FacilityType	Waiver

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