22D2278143 CLIA NUMBER - SUCCOR PRIMARY CARE, INC

Laboratory Demographics

  • CLIA Code: 22D2278143
  • Facility Name: SUCCOR PRIMARY CARE, INC
  • Facility Address: 24 CRESCENT ST STE 304
    WALTHAM, MA
    ZIP 02453
  • Facility Phone: 781 358-8633
  • Facility Type: Practitioner Other
  • Facility Type: Waiver
  • Lab Director: LELIA MAGOBA
  • NPI Number: 1295311207
  • Taxonomy: 363LP2300X - Nurse Practitioner

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CLIA Record

Field Name Field Value
CLIA Number 22D2278143
LAB Type Practitioner Other
Facility Name SUCCOR PRIMARY CARE, INC
Street 24 CRESCENT ST STE 304
City WALTHAM
State MA
ZIP 02453
Phone 781 358-8633
Certificate Type Certificate of Waiver
Certificate Type Description This certificate is issued to a laboratory to perform only waived tests.
Certificate Effective Date 3/13/2025
Certificate Expiration Date 3/12/2027
Facility Type Practitioner Other
Lab Director LELIA MAGOBA

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