22D2097822 CLIA NUMBER - COMMONWEALTH PEDIATRICS

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Laboratory Demographics

CLIA Number: 22D2097822

Facility Name: COMMONWEALTH PEDIATRICS

Facility Address:
92 MONTVALE AVE STE 4200
STONEHAM, MA
ZIP 02180
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Facility Phone Number: 781 451-0072

Facility Type: Physician Office

Certificate Type: Waiver

NPI Number: 1588051874

Taxonomy: 261QP2300X - Clinic/Center

CLIA Record

Field Name	Field Value
CLIA Number	22D2097822
LAB Type	Physician Office
Facility Name	COMMONWEALTH PEDIATRICS
Street	92 MONTVALE AVE STE 4200
City	STONEHAM
State	MA
ZIP	02180
Phone	781 451-0072
CertificateType	4
CertificateEffectiveDate	6/24/2023
CertificateExpirationDate	6/23/2025
FacilityType	Waiver

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