39D1105885 CLIA NUMBER - ADVOCARE FAIRMOUNT PEDIATRICS

Laboratory Demographics

  • CLIA Code: 39D1105885
  • Facility Name: ADVOCARE FAIRMOUNT PEDIATRICS
  • Facility Address: 2000 HAMILTON ST, SUITE 109
    PHILADELPHIA, PA
    ZIP 19130
  • Facility Phone: 215 774-1166
  • Facility Type: Physician Office
  • Facility Type: Waiver
  • Lab Director: ALEXIS S. LIEBERMAN
  • NPI Number: 1386288702
  • Taxonomy: 2080A0000X - Pediatrics

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CLIA Record

Field Name Field Value
CLIA Number 39D1105885
LAB Type Physician Office
Facility Name ADVOCARE FAIRMOUNT PEDIATRICS
Street 2000 HAMILTON ST, SUITE 109
City PHILADELPHIA
State PA
ZIP 19130
Phone 215 774-1166
Certificate Type Certificate of Waiver
Certificate Type Description This certificate is issued to a laboratory to perform only waived tests.
Certificate Effective Date 8/4/2024
Certificate Expiration Date 8/3/2026
Facility Type Physician Office
Lab Director ALEXIS S. LIEBERMAN

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