Provider Demographics
NPI:1851445563
Name:FERTILITY CENTER OF MARYLAND
Entity Type:Organization
Organization Name:FERTILITY CENTER OF MARYLAND
Other - Org Name:AMBULATORY SURGICAL CENTER
Other - Org Type:Other Name
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:SANTIAGO
Authorized Official - Middle Name:LUIS
Authorized Official - Last Name:PADILIA
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:410-296-5400
Mailing Address - Street 1:110 WEST ROAD
Mailing Address - Street 2:SUITE 102
Mailing Address - City:TOWSON
Mailing Address - State:MD
Mailing Address - Zip Code:21204
Mailing Address - Country:US
Mailing Address - Phone:410-296-6403
Mailing Address - Fax:410-296-6405
Practice Address - Street 1:110 WEST ROAD
Practice Address - Street 2:SUITE 102
Practice Address - City:TOWSON
Practice Address - State:MD
Practice Address - Zip Code:21204
Practice Address - Country:US
Practice Address - Phone:410-296-6403
Practice Address - Fax:410-296-6405
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-01-22
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MDD0035237163WR1000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes163WR1000XNursing Service ProvidersRegistered NurseReproductive Endocrinology/InfertilityGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
D76560Medicare UPIN
K867Medicare ID - Type Unspecified