33D1104135 CLIA NUMBER - PORTLAND PEDIATRIC GROUP LLP

Laboratory Demographics

  • CLIA Code: 33D1104135
  • Facility Name: PORTLAND PEDIATRIC GROUP LLP
  • Facility Address: 1700 HUDSON AVE
    ROCHESTER, NY
    ZIP 14617
  • Facility Phone: (585) 342-5665
  • Facility Type: Physician Office
  • Facility Type: Waiver
  • Lab Director: RODERICK G. DAVIS
  • NPI Number: 1174745285
  • Taxonomy: 208000000X - Pediatrics

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CLIA Record

Field Name Field Value
CLIA Number 33D1104135
LAB Type Physician Office
Facility Name PORTLAND PEDIATRIC GROUP LLP
Street 1700 HUDSON AVE
City ROCHESTER
State NY
ZIP 14617
Phone 5853425665
Certificate Type Certificate of Waiver
Certificate Type Description This certificate is issued to a laboratory to perform only waived tests.
Certificate Effective Date 8/26/2025
Certificate Expiration Date 8/25/2027
Facility Type Physician Office
Lab Director RODERICK G. DAVIS

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This page was last updated on: 5/18/2026