39D1048135 CLIA NUMBER - WELLSPAN FAMILY MEDICINE FREDERICK ST

Laboratory Demographics

  • CLIA Code: 39D1048135
  • Facility Name: WELLSPAN FAMILY MEDICINE FREDERICK ST
  • Facility Address: 100 FREDERICK STREET, SUITE 101
    HANOVER, PA
    ZIP 17331
  • Facility Phone: 717 632-7474
  • Facility Type: Physician Office
  • Facility Type: Waiver
  • Lab Director: DR. G PANISRI RAO
  • NPI Number: 1396211686
  • Taxonomy: 261QU0200X - Clinic/Center

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CLIA Record

Field Name Field Value
CLIA Number 39D1048135
LAB Type Physician Office
Facility Name WELLSPAN FAMILY MEDICINE FREDERICK ST
Street 100 FREDERICK STREET, SUITE 101
City HANOVER
State PA
ZIP 17331
Phone 717 632-7474
Certificate Type Certificate of Waiver
Certificate Type Description This certificate is issued to a laboratory to perform only waived tests.
Certificate Effective Date 6/21/2024
Certificate Expiration Date 6/20/2026
Facility Type Physician Office
Lab Director DR. G PANISRI RAO

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