49D2039805 CLIA NUMBER - KINGSTOWNE INTERNAL MEDICINE

Laboratory Demographics

  • CLIA Code: 49D2039805
  • Facility Name: KINGSTOWNE INTERNAL MEDICINE
  • Facility Address: 5901 KINGSTOWNE VILLAGE PARKWAY - SUITE 300
    ALEXANDRIA, VA
    ZIP 22315
  • Facility Phone: (571) 384-6304
  • Facility Type: Physician Office
  • Facility Type: Waiver
  • Lab Director: NIKKI R. WADDELL
  • NPI Number: 1841560299
  • Taxonomy: 207R00000X - Internal Medicine

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CLIA Record

Field Name Field Value
CLIA Number 49D2039805
LAB Type Physician Office
Facility Name KINGSTOWNE INTERNAL MEDICINE
Street 5901 KINGSTOWNE VILLAGE PARKWAY - SUITE 300
City ALEXANDRIA
State VA
ZIP 22315
Phone 5713846304
Certificate Type Certificate of Waiver
Certificate Type Description This certificate is issued to a laboratory to perform only waived tests.
Certificate Effective Date 4/18/2026
Certificate Expiration Date 4/17/2028
Facility Type Physician Office
Lab Director NIKKI R. WADDELL

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