34D1051890 CLIA NUMBER - INTRACOASTAL INTERNAL MEDICINE PA

Laboratory Demographics

  • CLIA Code: 34D1051890
  • Facility Name: INTRACOASTAL INTERNAL MEDICINE PA
  • Facility Address: 2580 PICKARD ROAD
    WILMINGTON, NC
    ZIP 28403
  • Facility Phone: 910 395-1543
  • Facility Type: Physician Office
  • Facility Type: Waiver
  • Lab Director: CHRIS C. COSGROVE
  • NPI Number: 1770515272
  • Taxonomy: 207R00000X - Internal Medicine

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CLIA Record

Field Name Field Value
CLIA Number 34D1051890
LAB Type Physician Office
Facility Name INTRACOASTAL INTERNAL MEDICINE PA
Street 2580 PICKARD ROAD
City WILMINGTON
State NC
ZIP 28403
Phone 910 395-1543
Certificate Type Certificate of Waiver
Certificate Type Description This certificate is issued to a laboratory to perform only waived tests.
Certificate Effective Date 3/14/2024
Certificate Expiration Date 3/13/2026
Facility Type Physician Office
Lab Director CHRIS C. COSGROVE

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