51D0910134 CLIA NUMBER - VANDALIA HEALTH PEDIATRICS - WCMSOB - SUITE 200

Laboratory Demographics

  • CLIA Code: 51D0910134
  • Facility Name: VANDALIA HEALTH PEDIATRICS - WCMSOB - SUITE 200
  • Facility Address: 830 PENNSYLVANIA AVE # 200
    CHARLESTON, WV
    ZIP 25302
  • Facility Phone: 304 388-9043
  • Facility Type: Physician Office
  • Facility Type: Waiver
  • Lab Director: DR. PENNY DIVITA
  • NPI Number: 1154429041
  • Taxonomy: 208000000X - Pediatrics

Map and Directions

Get Directions

CLIA Record

Field Name Field Value
CLIA Number 51D0910134
LAB Type Physician Office
Facility Name VANDALIA HEALTH PEDIATRICS - WCMSOB - SUITE 200
Street 830 PENNSYLVANIA AVE # 200
City CHARLESTON
State WV
ZIP 25302
Phone 304 388-9043
Certificate Type Certificate of Waiver
Certificate Type Description This certificate is issued to a laboratory to perform only waived tests.
Certificate Effective Date 12/28/2023
Certificate Expiration Date 12/27/2025
Facility Type Physician Office
Lab Director DR. PENNY DIVITA

Download Record

Download this CLIA record record in Text format: Export

Download this CLIA record record in Excel (CSV) format: Export

Download this CLIA record record in XML format: Export

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