33D0892246 CLIA NUMBER - LAKE CHAMPLAIN OB/GYN PC

Laboratory Demographics

  • CLIA Code: 33D0892246
  • Facility Name: LAKE CHAMPLAIN OB/GYN PC
  • Facility Address: 46 BROAD STREET SUITE A
    PLATTSBURGH, NY
    ZIP 12901
  • Facility Phone: 518 566-9452
  • Facility Type: Physician Office
  • Facility Type: Microscopy
  • Lab Director: JEFFREY A. DODGE DO
  • NPI Number: 1891708095
  • Taxonomy: 207V00000X - Obstetrics & Gynecology

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CLIA Record

Field Name Field Value
CLIA Number 33D0892246
LAB Type Physician Office
Facility Name LAKE CHAMPLAIN OB/GYN PC
Street 46 BROAD STREET SUITE A
City PLATTSBURGH
State NY
ZIP 12901
Phone 518 566-9452
Certificate Type Certificate for Provider-Performed Microscopy Procedures (PPMP)
Certificate Type Description This certificate is issued to a laboratory in which a physician, midlevel practitioner or dentist performs no tests other than the microscopy procedures. This certificate permits the laboratory to also perform waived tests.
Certificate Effective Date 9/27/2024
Certificate Expiration Date 9/26/2026
Facility Type Physician Office
Lab Director JEFFREY A. DODGE DO

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This page was last updated on: 3/20/2025