Provider Demographics
NPI:1013325125
Name:MONTGOMERY WOMEN'S MEDICAL CENTER, P.C.
Entity Type:Organization
Organization Name:MONTGOMERY WOMEN'S MEDICAL CENTER, P.C.
Other - Org Name:MONTGOMERY FERTILITY CENTER
Other - Org Type:Doing Business As
Authorized Official - Title/Position:MEDICAL DIRECTOR
Authorized Official - Prefix:DR
Authorized Official - First Name:OLUYEMISI
Authorized Official - Middle Name:
Authorized Official - Last Name:FAMUYIWA
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:301-946-6962
Mailing Address - Street 1:3202 TOWER OAKS BLVD
Mailing Address - Street 2:SUITE # 370
Mailing Address - City:ROCKVILLE
Mailing Address - State:MD
Mailing Address - Zip Code:20852-4219
Mailing Address - Country:US
Mailing Address - Phone:301-946-6962
Mailing Address - Fax:301-946-6022
Practice Address - Street 1:3202 TOWER OAKS BLVD
Practice Address - Street 2:SUITE # 370
Practice Address - City:ROCKVILLE
Practice Address - State:MD
Practice Address - Zip Code:20852-4219
Practice Address - Country:US
Practice Address - Phone:301-946-6962
Practice Address - Fax:301-946-6022
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2014-08-01
Last Update Date:2015-02-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MDD0044906207VE0102X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207VE0102XAllopathic & Osteopathic PhysiciansObstetrics & GynecologyReproductive EndocrinologyGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
MD676300600Medicaid
MD676300600Medicaid