41D2173268 CLIA NUMBER - LIFESPAN PHYSICIAN GROUP, INC

Laboratory Demographics

  • CLIA Code: 41D2173268
  • Facility Name: LIFESPAN PHYSICIAN GROUP, INC
  • Facility Address: 1360 W MAIN RD
    MIDDLETOWN, RI
    ZIP 02842
  • Facility Phone: 401 606-3110
  • Facility Type: Other - URGENT CARE
  • Facility Type: Waiver
  • Lab Director: OLIVIER M. GHERARDI DO
  • NPI Number: 1285191163
  • Taxonomy: 261QU0200X - Clinic/Center

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CLIA Record

Field Name Field Value
CLIA Number 41D2173268
LAB Type Other - URGENT CARE
Facility Name LIFESPAN PHYSICIAN GROUP, INC
Street 1360 W MAIN RD
City MIDDLETOWN
State RI
ZIP 02842
Phone 401 606-3110
Certificate Type Certificate of Waiver
Certificate Type Description This certificate is issued to a laboratory to perform only waived tests.
Certificate Effective Date 10/9/2025
Certificate Expiration Date 10/8/2027
Facility Type Other - URGENT CARE
Lab Director OLIVIER M. GHERARDI DO

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