38D2308797 CLIA NUMBER - SUMMIT DERMATOLOGY

Laboratory Demographics

  • CLIA Code: 38D2308797
  • Facility Name: SUMMIT DERMATOLOGY
  • Facility Address: 1910 E BARNETT RD, SUITE 101
    MEDFORD, OR
    ZIP 97504
  • Facility Phone: 541 200-2022
  • Facility Type: Practitioner Other
  • Facility Type: Waiver
  • Lab Director: MARIANA COOPER
  • NPI Number: 1952172686
  • Taxonomy: 207N00000X - Dermatology

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CLIA Record

Field Name Field Value
CLIA Number 38D2308797
LAB Type Practitioner Other
Facility Name SUMMIT DERMATOLOGY
Street 1910 E BARNETT RD, SUITE 101
City MEDFORD
State OR
ZIP 97504
Phone 541 200-2022
Certificate Type Certificate of Waiver
Certificate Type Description This certificate is issued to a laboratory to perform only waived tests.
Certificate Effective Date 8/2/2024
Certificate Expiration Date 8/1/2026
Facility Type Practitioner Other
Lab Director MARIANA COOPER

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