1437646494 NPI number — SHADY GROVE REPRODUCTIVE SCIENCE CENTER PC

Table of Contents

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1437646494 NPI number — SHADY GROVE REPRODUCTIVE SCIENCE CENTER PC

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
SHADY GROVE REPRODUCTIVE SCIENCE CENTER PC
Provider Last Name:
Provider First Name:
Provider Middle Name:
Provider Name Prefix Text:
Provider Name Suffix Text:
Provider Credential Text:
Provider Gender Code:

Provider's Other Name Information

Provider Other Organization Name:
SGF FAIRFAX PROCEDURE CENTER
Provider Other Organization Name Type Code:
3
Provider Other Last Name:
Provider Other First Name:
Provider Other Middle Name:
Provider Other Name Prefix Text:
Provider Other Name Suffix Text:
Provider Other Credential Text:
Provider Other Last Name Type Code:

NPI Number Information

NPI Number:
1437646494
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
04/16/2018
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
9600 BLACKWELL RD STE 500
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
ROCKVILLE
Provider Business Mailing Address State Name:
MD
Provider Business Mailing Address Postal Code:
20850-3783
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
301-340-1188
Provider Business Mailing Address Fax Number:
301-340-1612

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
8501 ARLINGTON BLVD STE 500
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
FAIRFAX
Provider Business Practice Location Address State Name:
VA
Provider Business Practice Location Address Postal Code:
22031-4631
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
703-876-0734
Provider Business Practice Location Address Fax Number:
703-876-4980
Provider Enumeration Date:
04/16/2018

Additional Information

Authorized Official

Authorized Official Last Name:
SHAPIRO
Authorized Official First Name:
SHELLY
Authorized Official Middle Name:
Authorized Official Title or Position:
CHIEF FINANCIAL OFFICER
Authorized Official Telephone Number:
301-545-1407

Provider Taxonomy Codes

  • Taxonomy code: 261QA0006X ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

Other Provider's Identifiers (legacy, non-NPI)





Copyright © 2007-2024 www.npivalidator.com