22D2006628 CLIA NUMBER - NEELAM M THACKER MD

Laboratory Demographics

  • CLIA Code: 22D2006628
  • Facility Name: NEELAM M THACKER MD
  • Facility Address: 101 MAIN STREET SUITE 210
    MEDFORD, MA
    ZIP 02155
  • Facility Phone: 781 396-8100
  • Facility Type: Physician Office
  • Facility Type: Waiver
  • Lab Director: NEELAM M. THACKER
  • NPI Number: 1790832822
  • Taxonomy: 207V00000X - Obstetrics & Gynecology

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CLIA Record

Field Name Field Value
CLIA Number 22D2006628
LAB Type Physician Office
Facility Name NEELAM M THACKER MD
Street 101 MAIN STREET SUITE 210
City MEDFORD
State MA
ZIP 02155
Phone 781 396-8100
Certificate Type Certificate of Waiver
Certificate Type Description This certificate is issued to a laboratory to perform only waived tests.
Certificate Effective Date 4/27/2024
Certificate Expiration Date 4/26/2026
Facility Type Physician Office
Lab Director NEELAM M. THACKER

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