51D1042617 CLIA NUMBER - APPALACHIAN SPRING DERMATOLOGY

Laboratory Demographics

  • CLIA Code: 51D1042617
  • Facility Name: APPALACHIAN SPRING DERMATOLOGY
  • Facility Address: 1812 COUNTRY CLUB ROAD SUITE 200
    FAIRMONT, WV
    ZIP 26554
  • Facility Phone: 304 368-0111
  • Facility Type: Physician Office
  • Facility Type: Microscopy
  • Lab Director: BETH SANTMYIRE ROSENBERGER MD PHD
  • NPI Number: 1568928877
  • Taxonomy: 103T00000X - Psychologist

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CLIA Record

Field Name Field Value
CLIA Number 51D1042617
LAB Type Physician Office
Facility Name APPALACHIAN SPRING DERMATOLOGY
Street 1812 COUNTRY CLUB ROAD SUITE 200
City FAIRMONT
State WV
ZIP 26554
Phone 304 368-0111
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 3/14/2024
Certificate Expiration Date 3/13/2026
Facility Type Physician Office
Lab Director BETH SANTMYIRE ROSENBERGER MD PHD

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