45D2129496 CLIA NUMBER - LEGACY DERMATOLOGY

Laboratory Demographics

  • CLIA Code: 45D2129496
  • Facility Name: LEGACY DERMATOLOGY
  • Facility Address: 3140 LEGACY DRIVE, SUITE 110
    FRISCO, TX
    ZIP 75034
  • Facility Phone: 214 618-1778
  • Facility Type: Physician Office
  • Facility Type: Microscopy
  • Lab Director: JENNIFER W. DHARAMSI
  • NPI Number: 1134588148
  • Taxonomy: 207N00000X - Dermatology

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CLIA Record

Field Name Field Value
CLIA Number 45D2129496
LAB Type Physician Office
Facility Name LEGACY DERMATOLOGY
Street 3140 LEGACY DRIVE, SUITE 110
City FRISCO
State TX
ZIP 75034
Phone 214 618-1778
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 4/20/2025
Certificate Expiration Date 4/19/2027
Facility Type Physician Office
Lab Director JENNIFER W. DHARAMSI

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