51D0977796 CLIA NUMBER - MARK L DOUGLAS DO

Laboratory Demographics

  • CLIA Code: 51D0977796
  • Facility Name: MARK L DOUGLAS DO
  • Facility Address: 5098 WEST WASHINGTON STREET SUITE 408
    CROSS LANES, WV
    ZIP 25313
  • Facility Phone: 304 776-5594
  • Facility Type: Physician Office
  • Facility Type: Waiver
  • Lab Director: MARK L. DOUGLAS DO
  • NPI Number: 1306974464
  • Taxonomy: 207R00000X - Internal Medicine

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CLIA Record

Field Name Field Value
CLIA Number 51D0977796
LAB Type Physician Office
Facility Name MARK L DOUGLAS DO
Street 5098 WEST WASHINGTON STREET SUITE 408
City CROSS LANES
State WV
ZIP 25313
Phone 304 776-5594
Certificate Type Certificate of Waiver
Certificate Type Description This certificate is issued to a laboratory to perform only waived tests.
Certificate Effective Date 9/7/2024
Certificate Expiration Date 9/6/2026
Facility Type Physician Office
Lab Director MARK L. DOUGLAS DO

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