39D0692381 CLIA NUMBER - PROVIDENCE PEDIATRICS

Laboratory Demographics

  • CLIA Code: 39D0692381
  • Facility Name: PROVIDENCE PEDIATRICS
  • Facility Address: 338 RUSSELL AVENUE
    WILLIAMSPORT, PA
    ZIP 17701
  • Facility Phone: 570 326-5720
  • Facility Type: Physician Office
  • Facility Type: Waiver
  • Lab Director: JOSEPH DEMAY MD
  • NPI Number: 1265575955
  • Taxonomy: 208000000X - Pediatrics

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CLIA Record

Field Name Field Value
CLIA Number 39D0692381
LAB Type Physician Office
Facility Name PROVIDENCE PEDIATRICS
Street 338 RUSSELL AVENUE
City WILLIAMSPORT
State PA
ZIP 17701
Phone 570 326-5720
Certificate Type Certificate of Waiver
Certificate Type Description This certificate is issued to a laboratory to perform only waived tests.
Certificate Effective Date 11/22/2024
Certificate Expiration Date 11/21/2026
Facility Type Physician Office
Lab Director JOSEPH DEMAY MD

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