49D1051520 CLIA NUMBER - VIENNA PRIMARY AND PREVENTIVE MEDICINE

Laboratory Demographics

CLIA Number: 49D1051520

Facility Name: VIENNA PRIMARY AND PREVENTIVE MEDICINE

Facility Address:
243 CHURCH STREET, NW - SUITE 100C
VIENNA, VA
ZIP 22180
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Facility Phone Number: 703 255-3067

Facility Type: Physician Office

Certificate Type: Microscopy

NPI Number: 1437195468

Taxonomy: 261QP2300X - Clinic/Center

CLIA Record

Field Name	Field Value
CLIA Number	49D1051520
LAB Type	Physician Office
Facility Name	VIENNA PRIMARY AND PREVENTIVE MEDICINE
Street	243 CHURCH STREET, NW - SUITE 100C
City	VIENNA
State	VA
ZIP	22180
Phone	703 255-3067
CertificateType	3
CertificateEffectiveDate	3/3/2024
CertificateExpirationDate	3/2/2026
FacilityType	PPMP

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This page was last updated on: 4/23/2024