39D0696889 CLIA NUMBER - SURYA KUMARI VANGORE MD PC

Laboratory Demographics

  • CLIA Code: 39D0696889
  • Facility Name: SURYA KUMARI VANGORE MD PC
  • Facility Address: 431 WEST ROOSEVELT BLVD
    PHILADELPHIA, PA
    ZIP 19120
  • Facility Phone: 215 455-3444
  • Facility Type: Physician Office
  • Facility Type: Waiver
  • Lab Director: SURYA K. VANGORE
  • NPI Number: 1750565263
  • Taxonomy: 302R00000X - Health Maintenance Organization

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CLIA Record

Field Name Field Value
CLIA Number 39D0696889
LAB Type Physician Office
Facility Name SURYA KUMARI VANGORE MD PC
Street 431 WEST ROOSEVELT BLVD
City PHILADELPHIA
State PA
ZIP 19120
Phone 215 455-3444
Certificate Type Certificate of Waiver
Certificate Type Description This certificate is issued to a laboratory to perform only waived tests.
Certificate Effective Date 5/5/2025
Certificate Expiration Date 5/4/2027
Facility Type Physician Office
Lab Director SURYA K. VANGORE

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