39D2065598 CLIA NUMBER - JOHN K WILDEMORE MD, LLC

Laboratory Demographics

  • CLIA Code: 39D2065598
  • Facility Name: JOHN K WILDEMORE MD, LLC
  • Facility Address: 744 WEST LANCASTER AVE SUITE 230
    WAYNE, PA
    ZIP 19087
  • Facility Phone: 610 688-8750
  • Facility Type: Physician Office
  • Facility Type: Certificate of Compliance
  • Lab Director: DR. TATYANA R. HUMPHREYS
  • NPI Number: 1295712487
  • Taxonomy: 207N00000X - Dermatology

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CLIA Record

Field Name Field Value
CLIA Number 39D2065598
LAB Type Physician Office
Facility Name JOHN K WILDEMORE MD, LLC
Street 744 WEST LANCASTER AVE SUITE 230
City WAYNE
State PA
ZIP 19087
Phone 610 688-8750
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 4/11/2024
Certificate Expiration Date 4/10/2026
Facility Type Physician Office
Lab Director DR. TATYANA R. HUMPHREYS

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