39D2118278 CLIA NUMBER - MAIN LINE ENDOCRINOLOGY

Laboratory Demographics

  • CLIA Code: 39D2118278
  • Facility Name: MAIN LINE ENDOCRINOLOGY
  • Facility Address: 1991 SPROUL ROAD, 2ND FLOOR
    BROOMALL, PA
    ZIP 19008
  • Facility Phone: 610 649-1922
  • Facility Type: Physician Office
  • Facility Type: Waiver
  • Lab Director: DR. DINA E. GREEN
  • NPI Number: 1710216791
  • Taxonomy: 207Q00000X - Family Medicine

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CLIA Record

Field Name Field Value
CLIA Number 39D2118278
LAB Type Physician Office
Facility Name MAIN LINE ENDOCRINOLOGY
Street 1991 SPROUL ROAD, 2ND FLOOR
City BROOMALL
State PA
ZIP 19008
Phone 610 649-1922
Certificate Type Certificate of Waiver
Certificate Type Description This certificate is issued to a laboratory to perform only waived tests.
Certificate Effective Date 9/6/2024
Certificate Expiration Date 9/5/2026
Facility Type Physician Office
Lab Director DR. DINA E. GREEN

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