49D2061084 CLIA NUMBER - MOUNT VERNON MEDICAL ASSOCIATES, PC

Laboratory Demographics

  • CLIA Code: 49D2061084
  • Facility Name: MOUNT VERNON MEDICAL ASSOCIATES, PC
  • Facility Address: 6128 BRANDON AVENUE - SUITE 201
    SPRINGFIELD, VA
    ZIP 22150
  • Facility Phone: 703 780-2800
  • Facility Type: Physician Office
  • Facility Type: Waiver
  • Lab Director: ALBERT A. HERRERA
  • NPI Number: 1659660413
  • Taxonomy: 2085R0202X - Radiology

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CLIA Record

Field Name Field Value
CLIA Number 49D2061084
LAB Type Physician Office
Facility Name MOUNT VERNON MEDICAL ASSOCIATES, PC
Street 6128 BRANDON AVENUE - SUITE 201
City SPRINGFIELD
State VA
ZIP 22150
Phone 703 780-2800
Certificate Type Certificate of Waiver
Certificate Type Description This certificate is issued to a laboratory to perform only waived tests.
Certificate Effective Date 8/31/2025
Certificate Expiration Date 8/30/2027
Facility Type Physician Office
Lab Director ALBERT A. HERRERA

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