36D1035830 CLIA NUMBER - PHOENIX DERMATOLOGY

Laboratory Demographics

CLIA Number: 36D1035830

Facility Name: PHOENIX DERMATOLOGY

Facility Address:
4340 FULTON ROAD
CANTON, OH
ZIP 44718
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Facility Phone Number: 330 832-6831

Facility Type: Physician Office

Certificate Type: Microscopy

NPI Number: 1285697060

Taxonomy: 174400000X - Specialist
An individual educated and trained in an applied knowledge discipline used in the performance of work at a level requiring knowledge and skills beyond or apart from that provided by a general education or liberal arts degree.

CLIA Record

Field Name	Field Value
CLIA Number	36D1035830
LAB Type	Physician Office
Facility Name	PHOENIX DERMATOLOGY
Street	4340 FULTON ROAD
City	CANTON
State	OH
ZIP	44718
Phone	330 832-6831
CertificateType	3
CertificateEffectiveDate	1/12/2023
CertificateExpirationDate	1/11/2025
FacilityType	PPMP

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This page was last updated on: 4/23/2024