Provider Demographics
NPI:1134678733
Name:PROCREATE. FERTILITY CENTER OF VIRGINIA
Entity Type:Organization
Organization Name:PROCREATE. FERTILITY CENTER OF VIRGINIA
Other - Org Name:PROCREATE. GYN AND INFERTILITY SERVICES
Other - Org Type:Doing Business As
Authorized Official - Title/Position:DIRECTOR
Authorized Official - Prefix:DR
Authorized Official - First Name:CHRISTIAN
Authorized Official - Middle Name:M
Authorized Official - Last Name:PEREZ
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:757-404-5892
Mailing Address - Street 1:300 MEDICAL PKWY
Mailing Address - Street 2:SUITE 200
Mailing Address - City:CHESAPEAKE
Mailing Address - State:VA
Mailing Address - Zip Code:23320-4985
Mailing Address - Country:US
Mailing Address - Phone:757-404-5892
Mailing Address - Fax:
Practice Address - Street 1:300 MEDICAL PKWY
Practice Address - Street 2:SUITE 200
Practice Address - City:CHESAPEAKE
Practice Address - State:VA
Practice Address - Zip Code:23320-4985
Practice Address - Country:US
Practice Address - Phone:757-404-5892
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2016-09-25
Last Update Date:2016-09-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA0101244192207VE0102X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207VE0102XAllopathic & Osteopathic PhysiciansObstetrics & GynecologyReproductive EndocrinologyGroup - Single Specialty