36D2291443 CLIA NUMBER - OHIODERM HOLDING INC

Laboratory Demographics

  • CLIA Code: 36D2291443
  • Facility Name: OHIODERM HOLDING INC
  • Facility Address: 812 REDSKIN TRAIL
    WAPAKONETA, OH
    ZIP 45895
  • Facility Phone: 419 549-5607
  • Facility Type: Physician Office
  • Facility Type: Waiver
  • Lab Director: MICHAEL P. CONROY
  • NPI Number: 1265297899
  • Taxonomy: 207N00000X - Dermatology

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CLIA Record

Field Name Field Value
CLIA Number 36D2291443
LAB Type Physician Office
Facility Name OHIODERM HOLDING INC
Street 812 REDSKIN TRAIL
City WAPAKONETA
State OH
ZIP 45895
Phone 419 549-5607
Certificate Type Certificate of Waiver
Certificate Type Description This certificate is issued to a laboratory to perform only waived tests.
Certificate Effective Date 4/17/2025
Certificate Expiration Date 4/16/2027
Facility Type Physician Office
Lab Director MICHAEL P. CONROY

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