39D2029190 CLIA NUMBER - MIDLANTIC LAB

Laboratory Demographics

  • CLIA Code: 39D2029190
  • Facility Name: MIDLANTIC LAB
  • Facility Address: 400 DAVIS DRIVE SUITE 200
    PLYMOUTH MEETING, PA
    ZIP 19462
  • Facility Phone: 215 517-3640
  • Facility Type: Physician Office
  • Facility Type: Waiver
  • Lab Director: DR. JEFFREY N. GORDON
  • NPI Number: 1952829350
  • Taxonomy: 208800000X - Urology

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CLIA Record

Field Name Field Value
CLIA Number 39D2029190
LAB Type Physician Office
Facility Name MIDLANTIC LAB
Street 400 DAVIS DRIVE SUITE 200
City PLYMOUTH MEETING
State PA
ZIP 19462
Phone 215 517-3640
Certificate Type Certificate of Waiver
Certificate Type Description This certificate is issued to a laboratory to perform only waived tests.
Certificate Effective Date 9/1/2025
Certificate Expiration Date 8/31/2027
Facility Type Physician Office
Lab Director DR. JEFFREY N. GORDON

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