Provider Demographics
NPI:1811224967
Name:MARYLAND IVF HEALTH & WELLNESS CENTER
Entity Type:Organization
Organization Name:MARYLAND IVF HEALTH & WELLNESS CENTER
Other - Org Name:MARYLAND IVF
Other - Org Type:Doing Business As
Authorized Official - Title/Position:MEDICAL DIRECTOR
Authorized Official - Prefix:DR
Authorized Official - First Name:DIANA
Authorized Official - Middle Name:P
Authorized Official - Last Name:BROOMFIELD
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:410-964-2229
Mailing Address - Street 1:9250 BENDIX ROAD NORTH
Mailing Address - Street 2:
Mailing Address - City:COLUMBIA
Mailing Address - State:MD
Mailing Address - Zip Code:21045-1832
Mailing Address - Country:US
Mailing Address - Phone:410-964-2229
Mailing Address - Fax:410-964-0009
Practice Address - Street 1:9250 BENDIX ROAD NORTH
Practice Address - Street 2:
Practice Address - City:COLUMBIA
Practice Address - State:MD
Practice Address - Zip Code:21045-1832
Practice Address - Country:US
Practice Address - Phone:410-964-2229
Practice Address - Fax:410-964-0009
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2009-11-11
Last Update Date:2009-11-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MDD0060312261QM2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QM2500XAmbulatory Health Care FacilitiesClinic/CenterMedical Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
MDNPI- 1144 036 902 65OtherNPI
MDG89706Medicare UPIN