49D1079793 CLIA NUMBER - CHESTER SQUARE FAMILY PRACTICE

Laboratory Demographics

  • CLIA Code: 49D1079793
  • Facility Name: CHESTER SQUARE FAMILY PRACTICE
  • Facility Address: 12200 IRONBRIDGE ROAD
    CHESTER, VA
    ZIP 23831
  • Facility Phone: 804 301-7943
  • Facility Type: Mobile Laboratory
  • Facility Type: Waiver
  • Lab Director: BRIAN G. BURIJON, MD
  • NPI Number: 1023292885
  • Taxonomy: 207Q00000X - Family Medicine

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CLIA Record

Field Name Field Value
CLIA Number 49D1079793
LAB Type Mobile Laboratory
Facility Name CHESTER SQUARE FAMILY PRACTICE
Street 12200 IRONBRIDGE ROAD
City CHESTER
State VA
ZIP 23831
Phone 804 301-7943
Certificate Type Certificate of Waiver
Certificate Type Description This certificate is issued to a laboratory to perform only waived tests.
Certificate Effective Date 2/7/2024
Certificate Expiration Date 2/6/2026
Facility Type Mobile Laboratory
Lab Director BRIAN G. BURIJON, MD

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