49D2011740 CLIA NUMBER - PRIMA MEDICINE

Laboratory Demographics

  • CLIA Code: 49D2011740
  • Facility Name: PRIMA MEDICINE
  • Facility Address: 3903 FAIR RIDGE DRIVE - SUITE 218
    FAIRFAX, VA
    ZIP 22033
  • Facility Phone: 703 870-3750
  • Facility Type: Physician Office
  • Facility Type: Waiver
  • Lab Director: CHETHENA V. RAO
  • NPI Number: 1619290582
  • Taxonomy: 207R00000X - Internal Medicine

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CLIA Record

Field Name Field Value
CLIA Number 49D2011740
LAB Type Physician Office
Facility Name PRIMA MEDICINE
Street 3903 FAIR RIDGE DRIVE - SUITE 218
City FAIRFAX
State VA
ZIP 22033
Phone 703 870-3750
Certificate Type Certificate of Waiver
Certificate Type Description This certificate is issued to a laboratory to perform only waived tests.
Certificate Effective Date 8/23/2024
Certificate Expiration Date 8/22/2026
Facility Type Physician Office
Lab Director CHETHENA V. RAO

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