39D1027913 CLIA NUMBER - PANDA BEAR PEDIATRICS LLC

Laboratory Demographics

  • CLIA Code: 39D1027913
  • Facility Name: PANDA BEAR PEDIATRICS LLC
  • Facility Address: 409 SECOND AVENUE SUITE 303
    COLLEGEVILLE, PA
    ZIP 19426
  • Facility Phone: (610) 409-8050
  • Facility Type: Physician Office
  • Facility Type: Waiver
  • Lab Director: LARISSA F. DOMINY DO
  • NPI Number: 1497788327
  • Taxonomy: 208000000X - Pediatrics

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CLIA Record

Field Name Field Value
CLIA Number 39D1027913
LAB Type Physician Office
Facility Name PANDA BEAR PEDIATRICS LLC
Street 409 SECOND AVENUE SUITE 303
City COLLEGEVILLE
State PA
ZIP 19426
Phone 6104098050
Certificate Type Certificate of Waiver
Certificate Type Description This certificate is issued to a laboratory to perform only waived tests.
Certificate Effective Date 7/16/2024
Certificate Expiration Date 7/15/2026
Facility Type Physician Office
Lab Director LARISSA F. DOMINY DO

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This page was last updated on: 5/18/2026