49D0952530 CLIA NUMBER - PINE GROVE PEDIATRICS PC

Laboratory Demographics

  • CLIA Code: 49D0952530
  • Facility Name: PINE GROVE PEDIATRICS PC
  • Facility Address: 8650 SUDLEY ROAD - SUITE 309
    MANASSAS, VA
    ZIP 20110
  • Facility Phone: 703 393-9494
  • Facility Type: Physician Office
  • Facility Type: Microscopy
  • Lab Director: ROBIN E. BRODIE
  • NPI Number: 1346303062
  • Taxonomy: 208000000X - Pediatrics

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CLIA Record

Field Name Field Value
CLIA Number 49D0952530
LAB Type Physician Office
Facility Name PINE GROVE PEDIATRICS PC
Street 8650 SUDLEY ROAD - SUITE 309
City MANASSAS
State VA
ZIP 20110
Phone 703 393-9494
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 10/15/2024
Certificate Expiration Date 10/14/2026
Facility Type Physician Office
Lab Director ROBIN E. BRODIE

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