Provider Demographics
NPI:1609644178
Name:VIRTUAL FERTILITY MANAGEMENT E-CLINIC LLC
Entity Type:Organization
Organization Name:VIRTUAL FERTILITY MANAGEMENT E-CLINIC LLC
Other - Org Name:INTEGRATIVE E-CLINIC AND FERTILITY OPTIMIZATION
Other - Org Type:Doing Business As
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:MARIA MONIQUE
Authorized Official - Middle Name:DIONES
Authorized Official - Last Name:PANGATONGAN
Authorized Official - Suffix:
Authorized Official - Credentials:FNP-C
Authorized Official - Phone:540-418-6800
Mailing Address - Street 1:85 ROSEWOOD DR
Mailing Address - Street 2:
Mailing Address - City:BARBOURSVILLE
Mailing Address - State:VA
Mailing Address - Zip Code:22923-8569
Mailing Address - Country:US
Mailing Address - Phone:540-418-6800
Mailing Address - Fax:
Practice Address - Street 1:4701 COX RD STE 285
Practice Address - Street 2:
Practice Address - City:GLEN ALLEN
Practice Address - State:VA
Practice Address - Zip Code:23060-6808
Practice Address - Country:US
Practice Address - Phone:540-418-6800
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:VIRTUAL FERTILITY MANAGEMENT E-CLINIC LLC
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2023-12-14
Last Update Date:2024-01-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes202D00000XAllopathic & Osteopathic PhysiciansIntegrative MedicineGroup - Multi-Specialty