41D0713087 CLIA NUMBER - BROADWAY OB/GYN

Laboratory Demographics

  • CLIA Code: 41D0713087
  • Facility Name: BROADWAY OB/GYN
  • Facility Address: 695 EDDY ST STE 21
    PROVIDENCE, RI
    ZIP 02903
  • Facility Phone: 401 272-1550
  • Facility Type: Physician Office
  • Facility Type: Waiver
  • Lab Director: FRED A. BROSCO
  • NPI Number: 1831315548
  • Taxonomy: 207V00000X - Obstetrics & Gynecology

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CLIA Record

Field Name Field Value
CLIA Number 41D0713087
LAB Type Physician Office
Facility Name BROADWAY OB/GYN
Street 695 EDDY ST STE 21
City PROVIDENCE
State RI
ZIP 02903
Phone 401 272-1550
Certificate Type Certificate of Waiver
Certificate Type Description This certificate is issued to a laboratory to perform only waived tests.
Certificate Effective Date 11/27/2023
Certificate Expiration Date 11/26/2025
Facility Type Physician Office
Lab Director FRED A. BROSCO

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