39D0941766 CLIA NUMBER - WELLSPAN INTERNAL MEDICINE FAYETTEVILLE

Laboratory Demographics

  • CLIA Code: 39D0941766
  • Facility Name: WELLSPAN INTERNAL MEDICINE FAYETTEVILLE
  • Facility Address: 130 EAST MAIN STREET
    FAYETTEVILLE, PA
    ZIP 17222
  • Facility Phone: 717 352-7881
  • Facility Type: Physician Office
  • Facility Type: Waiver
  • Lab Director: DR. YOGINDRA S. BALHARA
  • NPI Number: 1700567260
  • Taxonomy: 213E00000X - Podiatrist

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CLIA Record

Field Name Field Value
CLIA Number 39D0941766
LAB Type Physician Office
Facility Name WELLSPAN INTERNAL MEDICINE FAYETTEVILLE
Street 130 EAST MAIN STREET
City FAYETTEVILLE
State PA
ZIP 17222
Phone 717 352-7881
Certificate Type Certificate of Waiver
Certificate Type Description This certificate is issued to a laboratory to perform only waived tests.
Certificate Effective Date 3/3/2024
Certificate Expiration Date 3/2/2026
Facility Type Physician Office
Lab Director DR. YOGINDRA S. BALHARA

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