39D1084575 CLIA NUMBER - KEYSTONE DERM CTR FOR SKIN SURG LLC

Laboratory Demographics

  • CLIA Code: 39D1084575
  • Facility Name: KEYSTONE DERM CTR FOR SKIN SURG LLC
  • Facility Address: 2525 9TH AVENUE SUITE 2A
    ALTOONA, PA
    ZIP 16602
  • Facility Phone: 814 943-7546
  • Facility Type: Physician Office
  • Facility Type: Certificate of Compliance
  • Lab Director: DR. GREGORY J. FULCHIERO JR
  • NPI Number: 1720538051
  • Taxonomy: 261QP2000X - Clinic/Center

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CLIA Record

Field Name Field Value
CLIA Number 39D1084575
LAB Type Physician Office
Facility Name KEYSTONE DERM CTR FOR SKIN SURG LLC
Street 2525 9TH AVENUE SUITE 2A
City ALTOONA
State PA
ZIP 16602
Phone 814 943-7546
Certificate Type Certificate of Compliance
Certificate Type Description This certificate is issued to a laboratory after an inspection that finds the laboratory to be in compliance with all applicable CLIA requirements.
Certificate Effective Date 9/15/2024
Certificate Expiration Date 9/14/2026
Facility Type Physician Office
Lab Director DR. GREGORY J. FULCHIERO JR

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