39D0986677 CLIA NUMBER - JEANES FAMILY MEDICINE

Laboratory Demographics

  • CLIA Code: 39D0986677
  • Facility Name: JEANES FAMILY MEDICINE
  • Facility Address: 9331 OLD BUSTLETON AVENUE SUITE 101
    PHILADELPHIA, PA
    ZIP 19115
  • Facility Phone: 215 673-1520
  • Facility Type: Physician Office
  • Facility Type: Waiver
  • Lab Director: DR. MITCHELL J. MARDER DO
  • NPI Number: 1528395324
  • Taxonomy: 207Q00000X - Family Medicine

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CLIA Record

Field Name Field Value
CLIA Number 39D0986677
LAB Type Physician Office
Facility Name JEANES FAMILY MEDICINE
Street 9331 OLD BUSTLETON AVENUE SUITE 101
City PHILADELPHIA
State PA
ZIP 19115
Phone 215 673-1520
Certificate Type Certificate of Waiver
Certificate Type Description This certificate is issued to a laboratory to perform only waived tests.
Certificate Effective Date 8/24/2025
Certificate Expiration Date 8/23/2027
Facility Type Physician Office
Lab Director DR. MITCHELL J. MARDER DO

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