22D1050696 CLIA NUMBER - PREMISE HEALTH OF MASSACHUSETTS MEDICAL PC

Laboratory Demographics

  • CLIA Code: 22D1050696
  • Facility Name: PREMISE HEALTH OF MASSACHUSETTS MEDICAL PC
  • Facility Address: 35 GATEHOUSE DRIVE
    WALTHAM, MA
    ZIP 02451
  • Facility Phone: 781 701-5599
  • Facility Type: Physician Office
  • Facility Type: Waiver
  • Lab Director: JOHN CLARKE
  • NPI Number: 1861726937
  • Taxonomy: 261QX0100X - Clinic/Center

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CLIA Record

Field Name Field Value
CLIA Number 22D1050696
LAB Type Physician Office
Facility Name PREMISE HEALTH OF MASSACHUSETTS MEDICAL PC
Street 35 GATEHOUSE DRIVE
City WALTHAM
State MA
ZIP 02451
Phone 781 701-5599
Certificate Type Certificate of Waiver
Certificate Type Description This certificate is issued to a laboratory to perform only waived tests.
Certificate Effective Date 2/9/2024
Certificate Expiration Date 2/8/2026
Facility Type Physician Office
Lab Director JOHN CLARKE

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