39D0911483 CLIA NUMBER - LYCOMING INTERNAL MEDICINE INC

Laboratory Demographics

  • CLIA Code: 39D0911483
  • Facility Name: LYCOMING INTERNAL MEDICINE INC
  • Facility Address: ONE OUTLET LANE, SUITE 380
    LOCK HAVEN, PA
    ZIP 17745
  • Facility Phone: 570 398-1800
  • Facility Type: Physician Office
  • Facility Type: Waiver
  • Lab Director: RAJESH PATEL MD
  • NPI Number: 1861460867
  • Taxonomy: 207R00000X - Internal Medicine

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CLIA Record

Field Name Field Value
CLIA Number 39D0911483
LAB Type Physician Office
Facility Name LYCOMING INTERNAL MEDICINE INC
Street ONE OUTLET LANE, SUITE 380
City LOCK HAVEN
State PA
ZIP 17745
Phone 570 398-1800
Certificate Type Certificate of Waiver
Certificate Type Description This certificate is issued to a laboratory to perform only waived tests.
Certificate Effective Date 2/7/2024
Certificate Expiration Date 2/6/2026
Facility Type Physician Office
Lab Director RAJESH PATEL MD

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