41D2150385 CLIA NUMBER - MICHAEL P JOHNSON MD INC

Laboratory Demographics

  • CLIA Code: 41D2150385
  • Facility Name: MICHAEL P JOHNSON MD INC
  • Facility Address: 148 WEST RIVER ST STE 22B
    PROVIDENCE, RI
    ZIP 02904
  • Facility Phone: 401 521-7100
  • Facility Type: Physician Office
  • Facility Type: Waiver
  • Lab Director: CARLA M. MARTIN MD
  • NPI Number: 1407319163
  • Taxonomy: 363LF0000X - Nurse Practitioner

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CLIA Record

Field Name Field Value
CLIA Number 41D2150385
LAB Type Physician Office
Facility Name MICHAEL P JOHNSON MD INC
Street 148 WEST RIVER ST STE 22B
City PROVIDENCE
State RI
ZIP 02904
Phone 401 521-7100
Certificate Type Certificate of Waiver
Certificate Type Description This certificate is issued to a laboratory to perform only waived tests.
Certificate Effective Date 6/25/2024
Certificate Expiration Date 6/24/2026
Facility Type Physician Office
Lab Director CARLA M. MARTIN MD

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This page was last updated on: 3/20/2025