Provider Demographics
NPI:1639421936
Name:SHADY GROVE FERTILITY CENTER OF PA PLC
Entity Type:Organization
Organization Name:SHADY GROVE FERTILITY CENTER OF PA PLC
Other - Org Name:SGFC OF PA ENDOCRINE LAB
Other - Org Type:Other Name
Authorized Official - Title/Position:EXECUTIVE MANAGING DIRECTOR
Authorized Official - Prefix:
Authorized Official - First Name:VICKI
Authorized Official - Middle Name:
Authorized Official - Last Name:GERBER
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:301-545-1248
Mailing Address - Street 1:9600 BLACKWELL ROAD
Mailing Address - Street 2:SUITE 500
Mailing Address - City:ROCKVILLE
Mailing Address - State:MD
Mailing Address - Zip Code:20850
Mailing Address - Country:US
Mailing Address - Phone:301-340-1188
Mailing Address - Fax:855-716-1603
Practice Address - Street 1:735 CHESTERBROOK BLVD
Practice Address - Street 2:SUITE 100
Practice Address - City:CHESTERBROOK
Practice Address - State:PA
Practice Address - Zip Code:19087
Practice Address - Country:US
Practice Address - Phone:610-981-6000
Practice Address - Fax:855-437-5785
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:SHADY GROVE FERTILITY CENTER OF PA P
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2012-10-10
Last Update Date:2023-07-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PA022789A291U00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes291U00000XLaboratoriesClinical Medical Laboratory