22D0913117 CLIA NUMBER - MYSTIC VALLEY DERMATOLOGY ASSOCIATES

Laboratory Demographics

CLIA Number: 22D0913117

Facility Name: MYSTIC VALLEY DERMATOLOGY ASSOCIATES

Facility Address:
92 HIGH STREET SUITE T21
MEDFORD, MA
ZIP 02155
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Facility Phone Number: 781 438-6350

Facility Type: Physician Office

Certificate Type: Microscopy

NPI Number: 1548213606

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	22D0913117
LAB Type	Physician Office
Facility Name	MYSTIC VALLEY DERMATOLOGY ASSOCIATES
Street	92 HIGH STREET SUITE T21
City	MEDFORD
State	MA
ZIP	02155
Phone	781 438-6350
CertificateType	3
CertificateEffectiveDate	3/31/2024
CertificateExpirationDate	3/30/2026
FacilityType	PPMP

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