51D0687379 CLIA NUMBER - CHARLESTON DERMATOLOGY, PLLC

Laboratory Demographics

  • CLIA Code: 51D0687379
  • Facility Name: CHARLESTON DERMATOLOGY, PLLC
  • Facility Address: 4502 MACCORKLE AVENUE SE SUITE A
    CHARLESTON, WV
    ZIP 25304
  • Facility Phone: 304 925-5500
  • Facility Type: Physician Office
  • Facility Type: Microscopy
  • Lab Director: DR. SAMANTHA F. JENKINS
  • NPI Number: 1316325053
  • Taxonomy: 363A00000X - Physician Assistant

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CLIA Record

Field Name Field Value
CLIA Number 51D0687379
LAB Type Physician Office
Facility Name CHARLESTON DERMATOLOGY, PLLC
Street 4502 MACCORKLE AVENUE SE SUITE A
City CHARLESTON
State WV
ZIP 25304
Phone 304 925-5500
Certificate Type Certificate for Provider-Performed Microscopy Procedures (PPMP)
Certificate Type Description This certificate is issued to a laboratory in which a physician, midlevel practitioner or dentist performs no tests other than the microscopy procedures. This certificate permits the laboratory to also perform waived tests.
Certificate Effective Date 8/14/2025
Certificate Expiration Date 8/13/2027
Facility Type Physician Office
Lab Director DR. SAMANTHA F. JENKINS

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