49D1066097 CLIA NUMBER - RESTON EAR, NOSE AND THROAT

Laboratory Demographics

  • CLIA Code: 49D1066097
  • Facility Name: RESTON EAR, NOSE AND THROAT
  • Facility Address: 1860 TOWN CENTER DRIVE - SUITE 335
    RESTON, VA
    ZIP 20190
  • Facility Phone: (703) 787-3322
  • Facility Type: Physician Office
  • Facility Type: Waiver
  • Lab Director: EDWIN J. LEE
  • NPI Number: 1508961087
  • Taxonomy: 207Y00000X - Otolaryngology

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CLIA Record

Field Name Field Value
CLIA Number 49D1066097
LAB Type Physician Office
Facility Name RESTON EAR, NOSE AND THROAT
Street 1860 TOWN CENTER DRIVE - SUITE 335
City RESTON
State VA
ZIP 20190
Phone 7037873322
Certificate Type Certificate of Waiver
Certificate Type Description This certificate is issued to a laboratory to perform only waived tests.
Certificate Effective Date 4/25/2025
Certificate Expiration Date 4/24/2027
Facility Type Physician Office
Lab Director EDWIN J. LEE

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This page was last updated on: 6/29/2026