Provider Demographics
NPI:1003273822
Name:MATERNAL FETAL MEDICINE AND GENETICS PLC
Entity type:Organization
Organization Name:MATERNAL FETAL MEDICINE AND GENETICS PLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PHYSICIAN
Authorized Official - Prefix:DR
Authorized Official - First Name:SUSAN
Authorized Official - Middle Name:
Authorized Official - Last Name:PONKEY
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:480-773-7903
Mailing Address - Street 1:7380 E ALTA SIERRA DR
Mailing Address - Street 2:
Mailing Address - City:SCOTTSDALE
Mailing Address - State:AZ
Mailing Address - Zip Code:85266-1885
Mailing Address - Country:US
Mailing Address - Phone:480-773-7903
Mailing Address - Fax:480-773-6512
Practice Address - Street 1:1772 E. BOSTON STREET
Practice Address - Street 2:SUITE 107
Practice Address - City:GILBERT
Practice Address - State:AZ
Practice Address - Zip Code:85295-6243
Practice Address - Country:US
Practice Address - Phone:480-773-7903
Practice Address - Fax:480-773-6512
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2016-01-25
Last Update Date:2017-04-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QM2500XAmbulatory Health Care FacilitiesClinic/CenterMedical Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
AZ826480Medicaid
AZ119406Medicaid
AZF87900Medicare UPIN
AZ119406Medicaid
AZZ198827Medicare PIN