39D2189119 CLIA NUMBER - MAIN LINE ENDOCRINOLOGY IN MEDIA

Laboratory Demographics

  • CLIA Code: 39D2189119
  • Facility Name: MAIN LINE ENDOCRINOLOGY IN MEDIA
  • Facility Address: 2 WEST BALITIMORE AVE, SUITE 101
    MEDIA, PA
    ZIP 19063
  • Facility Phone: 484 227-0900
  • Facility Type: Physician Office
  • Facility Type: Waiver
  • Lab Director: DR. TASHA KOUVATSOS
  • NPI Number: 1043645948
  • Taxonomy: 2251X0800X - Physical Therapist

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CLIA Record

Field Name Field Value
CLIA Number 39D2189119
LAB Type Physician Office
Facility Name MAIN LINE ENDOCRINOLOGY IN MEDIA
Street 2 WEST BALITIMORE AVE, SUITE 101
City MEDIA
State PA
ZIP 19063
Phone 484 227-0900
Certificate Type Certificate of Waiver
Certificate Type Description This certificate is issued to a laboratory to perform only waived tests.
Certificate Effective Date 7/27/2024
Certificate Expiration Date 7/26/2026
Facility Type Physician Office
Lab Director DR. TASHA KOUVATSOS

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