39D2119393 CLIA NUMBER - CONCENTRA - FAR NORTHEAST PHILADELPHIA

Laboratory Demographics

  • CLIA Code: 39D2119393
  • Facility Name: CONCENTRA - FAR NORTHEAST PHILADELPHIA
  • Facility Address: 2804 SOUTHAMPTON ROAD
    PHILADELPHIA, PA
    ZIP 19154
  • Facility Phone: (215) 677-0930
  • Facility Type: Physician Office
  • Facility Type: Waiver
  • Lab Director: DR. THADDEUS D. DE HERRERA
  • NPI Number: 1023185147
  • Taxonomy: 3336C0003X - Pharmacy

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CLIA Record

Field Name Field Value
CLIA Number 39D2119393
LAB Type Physician Office
Facility Name CONCENTRA - FAR NORTHEAST PHILADELPHIA
Street 2804 SOUTHAMPTON ROAD
City PHILADELPHIA
State PA
ZIP 19154
Phone 2156770930
Certificate Type Certificate of Waiver
Certificate Type Description This certificate is issued to a laboratory to perform only waived tests.
Certificate Effective Date 9/27/2024
Certificate Expiration Date 9/26/2026
Facility Type Physician Office
Lab Director DR. THADDEUS D. DE HERRERA

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This page was last updated on: 5/18/2026