39D0987154 CLIA NUMBER - CITY LINE PEDIATRICS PC

Laboratory Demographics

  • CLIA Code: 39D0987154
  • Facility Name: CITY LINE PEDIATRICS PC
  • Facility Address: 4190 CITY LINE AVENUE SUITE 540
    PHILADELPHIA, PA
    ZIP 19131
  • Facility Phone: 215 871-1800
  • Facility Type: Physician Office
  • Facility Type: Waiver
  • Lab Director: ROSEMARY VICKERS DO
  • NPI Number: 1477588135
  • Taxonomy: 208000000X - Pediatrics

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CLIA Record

Field Name Field Value
CLIA Number 39D0987154
LAB Type Physician Office
Facility Name CITY LINE PEDIATRICS PC
Street 4190 CITY LINE AVENUE SUITE 540
City PHILADELPHIA
State PA
ZIP 19131
Phone 215 871-1800
Certificate Type Certificate of Waiver
Certificate Type Description This certificate is issued to a laboratory to perform only waived tests.
Certificate Effective Date 5/30/2025
Certificate Expiration Date 5/29/2027
Facility Type Physician Office
Lab Director ROSEMARY VICKERS DO

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