42D1023300 CLIA NUMBER - COASTAL NEUROLOGY

Laboratory Demographics

  • CLIA Code: 42D1023300
  • Facility Name: COASTAL NEUROLOGY
  • Facility Address: 1833 N PARIS AVENUE
    PORT ROYAL, SC
    ZIP 29935
  • Facility Phone: 843 522-1420
  • Facility Type: Physician Office
  • Facility Type: Waiver
  • Lab Director: PAUL MAZZEO
  • NPI Number: 1750346789
  • Taxonomy: 2084N0400X - Psychiatry & Neurology

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CLIA Record

Field Name Field Value
CLIA Number 42D1023300
LAB Type Physician Office
Facility Name COASTAL NEUROLOGY
Street 1833 N PARIS AVENUE
City PORT ROYAL
State SC
ZIP 29935
Phone 843 522-1420
Certificate Type Certificate of Waiver
Certificate Type Description This certificate is issued to a laboratory to perform only waived tests.
Certificate Effective Date 3/12/2024
Certificate Expiration Date 3/11/2026
Facility Type Physician Office
Lab Director PAUL MAZZEO

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