49D1101804 CLIA NUMBER - POTOMAC INTERNAL MEDICINE

Laboratory Demographics

  • CLIA Code: 49D1101804
  • Facility Name: POTOMAC INTERNAL MEDICINE
  • Facility Address: 3985 PRINCE WILLIAM PARKWAY - SUITE 102
    WOODBRIDGE, VA
    ZIP 22193
  • Facility Phone: 703 590-8375
  • Facility Type: Physician Office
  • Facility Type: Waiver
  • Lab Director: GOLESORKHI REZA, MD
  • NPI Number: 1255565339
  • Taxonomy: 207Q00000X - Family Medicine

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CLIA Record

Field Name Field Value
CLIA Number 49D1101804
LAB Type Physician Office
Facility Name POTOMAC INTERNAL MEDICINE
Street 3985 PRINCE WILLIAM PARKWAY - SUITE 102
City WOODBRIDGE
State VA
ZIP 22193
Phone 703 590-8375
Certificate Type Certificate of Waiver
Certificate Type Description This certificate is issued to a laboratory to perform only waived tests.
Certificate Effective Date 7/6/2025
Certificate Expiration Date 7/5/2027
Facility Type Physician Office
Lab Director GOLESORKHI REZA, MD

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