39D0693054 CLIA NUMBER - TEMPLE FACULTY PHYSICIANS-OBGYN

Laboratory Demographics

CLIA Code: 39D0693054
Facility Name: TEMPLE FACULTY PHYSICIANS-OBGYN
Facility Address: PHYSICIANS OFFICE BUILDING, SUITE 210 7500 CENTRAL AVENUE
PHILADELPHIA, PA
ZIP 19111
Facility Phone: 215 745-8989
Facility Type: Physician Office
Facility Type: Microscopy
Lab Director: DR. SAMANTHA SO
NPI Number: 1073665600
Taxonomy: 2080N0001X - Pediatrics

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CLIA Record

Field Name	Field Value
CLIA Number	39D0693054
LAB Type	Physician Office
Facility Name	TEMPLE FACULTY PHYSICIANS-OBGYN
Street	PHYSICIANS OFFICE BUILDING, SUITE 210 7500 CENTRAL AVENUE
City	PHILADELPHIA
State	PA
ZIP	19111
Phone	215 745-8989
Certificate Type	Certificate for Provider-Performed Microscopy Procedures (PPMP)
Certificate Type Description	This certificate is issued to a laboratory in which a physician, midlevel practitioner or dentist performs no tests other than the microscopy procedures. This certificate permits the laboratory to also perform waived tests.
Certificate Effective Date	9/1/2024
Certificate Expiration Date	8/31/2026
Facility Type	Physician Office
Lab Director	DR. SAMANTHA SO

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