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39D0930835 CLIA NUMBER - PROVIDENCE PEDIATRIC PRACTICE, LLC

Laboratory Demographics

CLIA Number: 39D0930835

Facility Name: PROVIDENCE PEDIATRIC PRACTICE, LLC

Facility Address:
100 GRANITE DRIVE,SUITE 200
MEDIA, PA
ZIP 19063
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Facility Phone Number: 610 892-8957

Facility Type: Physician Office

Certificate Type: Waiver
NPI Number: 1134680747

Taxonomy: 207Y00000X - Otolaryngology
An otolaryngologist-head and neck surgeon provides comprehensive medical and surgical care for patients with diseases and disorders that affect the ears, nose, throat, the respiratory and upper alimentary systems and related structures of the head and neck. An otolaryngologist diagnoses and provides medical and/or surgical therapy or prevention of diseases, allergies, neoplasms, deformities, disorders and/or injuries of the ears, nose, sinuses, throat, respiratory and upper alimentary systems, face, jaws and the other head and neck systems. Head and neck oncology, facial plastic and reconstructive surgery and the treatment of disorders of hearing and voice are fundamental areas of expertise.

CLIA Record

Field Name Field Value
CLIA Number 39D0930835
LAB Type Physician Office
Facility Name PROVIDENCE PEDIATRIC PRACTICE, LLC
Street 100 GRANITE DRIVE,SUITE 200
City MEDIA
State PA
ZIP 19063
Phone 610 892-8957
CertificateType 4
CertificateEffectiveDate 7/18/2023
CertificateExpirationDate 7/17/2025
FacilityType Waiver

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This page was last updated on: 4/23/2024