39D2259489 CLIA NUMBER - DEVINE CONCIERGE MEDICINE, LLC

Laboratory Demographics

  • CLIA Code: 39D2259489
  • Facility Name: DEVINE CONCIERGE MEDICINE, LLC
  • Facility Address: 165 RIDGEWOOD ROAD
    WAYNE, PA
    ZIP 19087
  • Facility Phone: 610 486-5980
  • Facility Type: Physician Office
  • Facility Type: Waiver
  • Lab Director: DANIEL J. DEVINE
  • NPI Number: 1093324527
  • Taxonomy: 207R00000X - Internal Medicine

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CLIA Record

Field Name Field Value
CLIA Number 39D2259489
LAB Type Physician Office
Facility Name DEVINE CONCIERGE MEDICINE, LLC
Street 165 RIDGEWOOD ROAD
City WAYNE
State PA
ZIP 19087
Phone 610 486-5980
Certificate Type Certificate of Waiver
Certificate Type Description This certificate is issued to a laboratory to perform only waived tests.
Certificate Effective Date 5/6/2024
Certificate Expiration Date 5/5/2026
Facility Type Physician Office
Lab Director DANIEL J. DEVINE

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