49D0702900 CLIA NUMBER - PEDIATRIC GROUP PC AT PATRIOT SQUARE,THE

Laboratory Demographics

  • CLIA Code: 49D0702900
  • Facility Name: PEDIATRIC GROUP PC AT PATRIOT SQUARE,THE
  • Facility Address: 10334 FAIRFAX BLVD
    FAIRFAX, VA
    ZIP 22030
  • Facility Phone: 703 425-3300
  • Facility Type: Physician Office
  • Facility Type: Waiver
  • Lab Director: ELIZABETH PALUMBO, MD
  • NPI Number: 1811168081
  • Taxonomy: 208000000X - Pediatrics

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CLIA Record

Field Name Field Value
CLIA Number 49D0702900
LAB Type Physician Office
Facility Name PEDIATRIC GROUP PC AT PATRIOT SQUARE,THE
Street 10334 FAIRFAX BLVD
City FAIRFAX
State VA
ZIP 22030
Phone 703 425-3300
Certificate Type Certificate of Waiver
Certificate Type Description This certificate is issued to a laboratory to perform only waived tests.
Certificate Effective Date 5/21/2024
Certificate Expiration Date 5/20/2026
Facility Type Physician Office
Lab Director ELIZABETH PALUMBO, MD

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This page was last updated on: 6/4/2025