39D1075729 CLIA NUMBER - MEMORIAL FAMILY MEDICINE AT BROGUE

Laboratory Demographics

  • CLIA Code: 39D1075729
  • Facility Name: MEMORIAL FAMILY MEDICINE AT BROGUE
  • Facility Address: 2500 DELTA ROAD
    BROGUE, PA
    ZIP 17309
  • Facility Phone: 717 927-8434
  • Facility Type: Physician Office
  • Facility Type: Waiver
  • Lab Director: DR. DOUG BRENNEMAN
  • NPI Number: 1386173763
  • Taxonomy: 207Q00000X - Family Medicine

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CLIA Record

Field Name Field Value
CLIA Number 39D1075729
LAB Type Physician Office
Facility Name MEMORIAL FAMILY MEDICINE AT BROGUE
Street 2500 DELTA ROAD
City BROGUE
State PA
ZIP 17309
Phone 717 927-8434
Certificate Type Certificate of Waiver
Certificate Type Description This certificate is issued to a laboratory to perform only waived tests.
Certificate Effective Date 10/26/2023
Certificate Expiration Date 10/25/2025
Facility Type Physician Office
Lab Director DR. DOUG BRENNEMAN

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