22D2317786 CLIA NUMBER - SUSTACHE PRIMARY CARE LLC

Laboratory Demographics

  • CLIA Code: 22D2317786
  • Facility Name: SUSTACHE PRIMARY CARE LLC
  • Facility Address: 65 BOSTON POST ROAD WEST SUITE 100
    MARLBOROUGH, MA
    ZIP 01752
  • Facility Phone: 508 422-4844
  • Facility Type: Physician Office
  • Facility Type: Waiver
  • Lab Director: GILBERTO SUSTACHE
  • NPI Number: 1336955954
  • Taxonomy: 207Q00000X - Family Medicine

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CLIA Record

Field Name Field Value
CLIA Number 22D2317786
LAB Type Physician Office
Facility Name SUSTACHE PRIMARY CARE LLC
Street 65 BOSTON POST ROAD WEST SUITE 100
City MARLBOROUGH
State MA
ZIP 01752
Phone 508 422-4844
Certificate Type Certificate of Waiver
Certificate Type Description This certificate is issued to a laboratory to perform only waived tests.
Certificate Effective Date 1/31/2025
Certificate Expiration Date 1/30/2027
Facility Type Physician Office
Lab Director GILBERTO SUSTACHE

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