1497117113 NPI number — FERTILITY PARTNERS OF PENNSYLVANIA SURGERY CENTER, LLC

Table of content: (NPI 1497117113)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1497117113 NPI number — FERTILITY PARTNERS OF PENNSYLVANIA SURGERY CENTER, LLC

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
FERTILITY PARTNERS OF PENNSYLVANIA SURGERY CENTER, LLC
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:
Provider Other Organization Name Type Code:
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:
1497117113
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
04/28/2023
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
9600 BLACKWELL ROAD
Provider Second Line Business Mailing Address:
SUITE 500
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:
855-716-1603

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
735 CHESTERBROOK BLVD
Provider Second Line Business Practice Location Address:
SUITE 110
Provider Business Practice Location Address City Name:
CHESTERBROOK
Provider Business Practice Location Address State Name:
PA
Provider Business Practice Location Address Postal Code:
19087-5638
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
610-981-6000
Provider Business Practice Location Address Fax Number:
855-437-5785
Provider Enumeration Date:
03/22/2016

Additional Information

Authorized Official

Authorized Official Last Name:
GERBER
Authorized Official First Name:
VICKI
Authorized Official Middle Name:
Authorized Official Title or Position:
EXECUTIVE MANAGING DIRECTOR
Authorized Official Telephone Number:
301-545-1248

Provider Taxonomy Codes

  • Taxonomy code: 261QA1903X ; 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