49D0692122 CLIA NUMBER - BOULEVARD CENTER PEDIATRICS INC

Laboratory Demographics

  • CLIA Code: 49D0692122
  • Facility Name: BOULEVARD CENTER PEDIATRICS INC
  • Facility Address: 3733 FETTLER PARK DR
    DUMFRIES, VA
    ZIP 22025
  • Facility Phone: 703 670-0300
  • Facility Type: Physician Office
  • Facility Type: Waiver
  • Lab Director: SHAILESH K. GOHEL
  • NPI Number: 1568706158
  • Taxonomy: 208000000X - Pediatrics

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CLIA Record

Field Name Field Value
CLIA Number 49D0692122
LAB Type Physician Office
Facility Name BOULEVARD CENTER PEDIATRICS INC
Street 3733 FETTLER PARK DR
City DUMFRIES
State VA
ZIP 22025
Phone 703 670-0300
Certificate Type Certificate of Waiver
Certificate Type Description This certificate is issued to a laboratory to perform only waived tests.
Certificate Effective Date 6/1/2024
Certificate Expiration Date 5/31/2026
Facility Type Physician Office
Lab Director SHAILESH K. GOHEL

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