49D1012811 CLIA NUMBER - TIDEWATER PERINATAL CENTER EASTERN VIRGINIA MEDICAL SCHOOL

Laboratory Demographics

  • CLIA Code: 49D1012811
  • Facility Name: TIDEWATER PERINATAL CENTER EASTERN VIRGINIA MEDICAL SCHOOL
  • Facility Address: 2075 GLENN MITCHELL DRIVE - SUITE 500
    VIRGINIA BEACH, VA
    ZIP 23456
  • Facility Phone: 757 395-8900
  • Facility Type: Physician Office
  • Facility Type: Microscopy
  • Lab Director: MARGARITA DE VECIANA MD
  • NPI Number: 1134876337
  • Taxonomy: 207R00000X - Internal Medicine

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CLIA Record

Field Name Field Value
CLIA Number 49D1012811
LAB Type Physician Office
Facility Name TIDEWATER PERINATAL CENTER EASTERN VIRGINIA MEDICAL SCHOOL
Street 2075 GLENN MITCHELL DRIVE - SUITE 500
City VIRGINIA BEACH
State VA
ZIP 23456
Phone 757 395-8900
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 9/10/2024
Certificate Expiration Date 9/9/2026
Facility Type Physician Office
Lab Director MARGARITA DE VECIANA MD

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