Provider Demographics
NPI:1801000625
Name:VIRGINIA CENTER FOR REPRODUCTIVE MEDICINE
Entity Type:Organization
Organization Name:VIRGINIA CENTER FOR REPRODUCTIVE MEDICINE
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:MEDICAL DIRECTOR
Authorized Official - Prefix:DR
Authorized Official - First Name:FADY
Authorized Official - Middle Name:I
Authorized Official - Last Name:SHARARA
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:703-437-7722
Mailing Address - Street 1:11150 SUNSET HILLS RD
Mailing Address - Street 2:SUITE 100
Mailing Address - City:RESTON
Mailing Address - State:VA
Mailing Address - Zip Code:20190-5360
Mailing Address - Country:US
Mailing Address - Phone:703-437-0066
Mailing Address - Fax:
Practice Address - Street 1:11150 SUNSET HILLS RD
Practice Address - Street 2:
Practice Address - City:RESTON
Practice Address - State:VA
Practice Address - Zip Code:20190-5360
Practice Address - Country:US
Practice Address - Phone:703-437-7722
Practice Address - Fax:703-437-0066
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-05-10
Last Update Date:2009-04-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA0101058651174400000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes174400000XOther Service ProvidersSpecialistGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
VA440239OtherVA BLUE CROSS PROVIDER
391589OtherONE NET ALLIANCE PROVIDER
391589OtherMAMSI OPT CHOICE MDIPA