30D2044558 CLIA NUMBER - MYSTIC VALLEY DERMATOLOGY ASSOCIATES

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Laboratory Demographics

CLIA Number: 30D2044558

Facility Name: MYSTIC VALLEY DERMATOLOGY ASSOCIATES

Facility Address:
29 STILES RD, STE 303
SALEM, NH
ZIP 03079
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Facility Phone Number: 781 438-6350

Facility Type: Physician Office

Certificate Type: Certificate of Compliance

NPI Number: 1548213606

Taxonomy: 174400000X - Specialist
An individual educated and trained in an applied knowledge discipline used in the performance of work at a level requiring knowledge and skills beyond or apart from that provided by a general education or liberal arts degree.

CLIA Record

Field Name	Field Value
CLIA Number	30D2044558
LAB Type	Physician Office
Facility Name	MYSTIC VALLEY DERMATOLOGY ASSOCIATES
Street	29 STILES RD, STE 303
City	SALEM
State	NH
ZIP	03079
Phone	781 438-6350
CertificateType	2
CertificateEffectiveDate	4/3/2023
CertificateExpirationDate	4/2/2025
FacilityType	Compliance

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