41D2183456 CLIA NUMBER - LIFESPAN PHYSICIAN GROUP, INC

Laboratory Demographics

  • CLIA Code: 41D2183456
  • Facility Name: LIFESPAN PHYSICIAN GROUP, INC
  • Facility Address: 66 BRANCH AVE SUITE 150
    PROVIDENCE, RI
    ZIP 02904
  • Facility Phone: 401 606-2590
  • Facility Type: Other - URGENT CARE
  • Facility Type: Waiver
  • Lab Director: OLIVER M. GHERARDI DO
  • NPI Number: 1144792383
  • Taxonomy: 3336C0003X - Pharmacy

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CLIA Record

Field Name Field Value
CLIA Number 41D2183456
LAB Type Other - URGENT CARE
Facility Name LIFESPAN PHYSICIAN GROUP, INC
Street 66 BRANCH AVE SUITE 150
City PROVIDENCE
State RI
ZIP 02904
Phone 401 606-2590
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 Other - URGENT CARE
Lab Director OLIVER M. GHERARDI DO

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