34D2260900 CLIA NUMBER - WESTERN WAKE INTERNAL MEDICINE

Laboratory Demographics

  • CLIA Code: 34D2260900
  • Facility Name: WESTERN WAKE INTERNAL MEDICINE
  • Facility Address: 907 KILDARE FARM ROAD
    CARY, NC
    ZIP 27511
  • Facility Phone: (919) 319-6610
  • Facility Type: Physician Office
  • Facility Type: Waiver
  • Lab Director: RAJ POLAVARAM
  • NPI Number: 1811209901
  • Taxonomy: 332900000X - Non-Pharmacy Dispensing Site

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CLIA Record

Field Name Field Value
CLIA Number 34D2260900
LAB Type Physician Office
Facility Name WESTERN WAKE INTERNAL MEDICINE
Street 907 KILDARE FARM ROAD
City CARY
State NC
ZIP 27511
Phone 9193196610
Certificate Type Certificate of Waiver
Certificate Type Description This certificate is issued to a laboratory to perform only waived tests.
Certificate Effective Date 5/24/2024
Certificate Expiration Date 5/23/2026
Facility Type Physician Office
Lab Director RAJ POLAVARAM

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