39D2193983 CLIA NUMBER - GEISINGER 65 FORWARD WILKES BARRE

Laboratory Demographics

  • CLIA Code: 39D2193983
  • Facility Name: GEISINGER 65 FORWARD WILKES BARRE
  • Facility Address: 41 SOUTH MAIN ST
    WILKES BARRE, PA
    ZIP 18701
  • Facility Phone: 570 808-7917
  • Facility Type: Physician Office
  • Facility Type: Waiver
  • Lab Director: DR. GEORGE K. AVETIAN
  • NPI Number: 1629681150
  • Taxonomy: 207Q00000X - Family Medicine

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CLIA Record

Field Name Field Value
CLIA Number 39D2193983
LAB Type Physician Office
Facility Name GEISINGER 65 FORWARD WILKES BARRE
Street 41 SOUTH MAIN ST
City WILKES BARRE
State PA
ZIP 18701
Phone 570 808-7917
Certificate Type Certificate of Waiver
Certificate Type Description This certificate is issued to a laboratory to perform only waived tests.
Certificate Effective Date 9/28/2024
Certificate Expiration Date 9/27/2026
Facility Type Physician Office
Lab Director DR. GEORGE K. AVETIAN

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