39D1048135 CLIA NUMBER - WELLSPAN FAMILY MEDICINE FREDERICK ST

Laboratory Demographics

CLIA Number: 39D1048135

Facility Name: WELLSPAN FAMILY MEDICINE FREDERICK ST

Facility Address:
100 FREDERICK STREET, SUITE 101
HANOVER, PA
ZIP 17331
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Facility Phone Number: 717 632-7474

Facility Type: Physician Office

Certificate Type: Waiver

NPI Number: 1396211686

Taxonomy: 261QP2300X - Clinic/Center

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
CertificateType	4
CertificateEffectiveDate	6/21/2022
CertificateExpirationDate	6/20/2024
FacilityType	Waiver

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This page was last updated on: 4/23/2024