45D2117217 CLIA NUMBER - LAKEWOOD DERMATOLOGY

Laboratory Demographics

  • CLIA Code: 45D2117217
  • Facility Name: LAKEWOOD DERMATOLOGY
  • Facility Address: 6162 E MOCKINGBIRD LANE, SUITE 120
    DALLAS, TX
    ZIP 75214
  • Facility Phone: 732 996-7276
  • Facility Type: Physician Office
  • Facility Type: Microscopy
  • Lab Director: PATRICK H. MCDONOUGH
  • NPI Number: 1710231824
  • Taxonomy: 101YP2500X - Counselor

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CLIA Record

Field Name Field Value
CLIA Number 45D2117217
LAB Type Physician Office
Facility Name LAKEWOOD DERMATOLOGY
Street 6162 E MOCKINGBIRD LANE, SUITE 120
City DALLAS
State TX
ZIP 75214
Phone 732 996-7276
Certificate Type Certificate for Provider-Performed Microscopy Procedures (PPMP)
Certificate Type Description This certificate is issued to a laboratory in which a physician, midlevel practitioner or dentist performs no tests other than the microscopy procedures. This certificate permits the laboratory to also perform waived tests.
Certificate Effective Date 8/11/2024
Certificate Expiration Date 8/10/2026
Facility Type Physician Office
Lab Director PATRICK H. MCDONOUGH

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