49D1026249 CLIA NUMBER - LAKE RIDGE INTERNAL MEDICINE

Laboratory Demographics

  • CLIA Code: 49D1026249
  • Facility Name: LAKE RIDGE INTERNAL MEDICINE
  • Facility Address: 1725 FINANCIAL LOOP
    WOODBRIDGE, VA
    ZIP 22192
  • Facility Phone: 703 492-1108
  • Facility Type: Physician Office
  • Facility Type: Waiver
  • Lab Director: BASSAM FARAH
  • NPI Number: 1316163256
  • Taxonomy: 207R00000X - Internal Medicine

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CLIA Record

Field Name Field Value
CLIA Number 49D1026249
LAB Type Physician Office
Facility Name LAKE RIDGE INTERNAL MEDICINE
Street 1725 FINANCIAL LOOP
City WOODBRIDGE
State VA
ZIP 22192
Phone 703 492-1108
Certificate Type Certificate of Waiver
Certificate Type Description This certificate is issued to a laboratory to perform only waived tests.
Certificate Effective Date 5/28/2024
Certificate Expiration Date 5/27/2026
Facility Type Physician Office
Lab Director BASSAM FARAH

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