39D0978526 CLIA NUMBER - COMMONWEALTH HEALTH PHYSICIAN NETWORK

Laboratory Demographics

  • CLIA Code: 39D0978526
  • Facility Name: COMMONWEALTH HEALTH PHYSICIAN NETWORK
  • Facility Address: 920 WYOMING AVENUE SUITE 103
    FORTY FORT, PA
    ZIP 18704
  • Facility Phone: 570 714-7500
  • Facility Type: Physician Office
  • Facility Type: Waiver
  • Lab Director: LOREN A. MANGINO
  • NPI Number: 1356397673
  • Taxonomy: 207Q00000X - Family Medicine

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CLIA Record

Field Name Field Value
CLIA Number 39D0978526
LAB Type Physician Office
Facility Name COMMONWEALTH HEALTH PHYSICIAN NETWORK
Street 920 WYOMING AVENUE SUITE 103
City FORTY FORT
State PA
ZIP 18704
Phone 570 714-7500
Certificate Type Certificate of Waiver
Certificate Type Description This certificate is issued to a laboratory to perform only waived tests.
Certificate Effective Date 9/26/2024
Certificate Expiration Date 9/25/2026
Facility Type Physician Office
Lab Director LOREN A. MANGINO

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