Provider Demographics
NPI:1922353366
Name:SHADY GROVE FERTILITY CENTER OF PENNSYLVANIA PLC
Entity Type:Organization
Organization Name:SHADY GROVE FERTILITY CENTER OF PENNSYLVANIA PLC
Other - Org Name:
Other - Org Type:
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:20850-3783
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:19087-5638
Practice Address - Country:US
Practice Address - Phone:610-981-6000
Practice Address - Fax:855-437-5785
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2012-07-23
Last Update Date:2023-04-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207VE0102XAllopathic & Osteopathic PhysiciansObstetrics & GynecologyReproductive EndocrinologyGroup - Single Specialty