34D2083080 CLIA NUMBER - MIDTOWN DERMATOLOGY PC

Laboratory Demographics

  • CLIA Code: 34D2083080
  • Facility Name: MIDTOWN DERMATOLOGY PC
  • Facility Address: 5904 SIX FORKS ROAD, SUITE 211
    RALEIGH, NC
    ZIP 27609
  • Facility Phone: 984 242-0510
  • Facility Type: Physician Office
  • Facility Type: Microscopy
  • Lab Director: BETH SCHULZ-BUTULIS
  • NPI Number: 1205242252
  • Taxonomy: 207N00000X - Dermatology

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CLIA Record

Field Name Field Value
CLIA Number 34D2083080
LAB Type Physician Office
Facility Name MIDTOWN DERMATOLOGY PC
Street 5904 SIX FORKS ROAD, SUITE 211
City RALEIGH
State NC
ZIP 27609
Phone 984 242-0510
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 8/27/2024
Certificate Expiration Date 8/26/2026
Facility Type Physician Office
Lab Director BETH SCHULZ-BUTULIS

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