39D0190094 CLIA NUMBER - LVPG INT MED - WEST BROAD

Laboratory Demographics

  • CLIA Code: 39D0190094
  • Facility Name: LVPG INT MED - WEST BROAD
  • Facility Address: 325 W BROAD ST 1ST FLOOR
    BETHLEHEM, PA
    ZIP 18018
  • Facility Phone: 610 867-3874
  • Facility Type: Physician Office
  • Facility Type: Waiver
  • Lab Director: DR. DIANA E. FARRELL
  • NPI Number: 1235537028
  • Taxonomy: 207R00000X - Internal Medicine

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CLIA Record

Field Name Field Value
CLIA Number 39D0190094
LAB Type Physician Office
Facility Name LVPG INT MED - WEST BROAD
Street 325 W BROAD ST 1ST FLOOR
City BETHLEHEM
State PA
ZIP 18018
Phone 610 867-3874
Certificate Type Certificate of Waiver
Certificate Type Description This certificate is issued to a laboratory to perform only waived tests.
Certificate Effective Date 8/19/2024
Certificate Expiration Date 8/18/2026
Facility Type Physician Office
Lab Director DR. DIANA E. FARRELL

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