Provider Demographics
NPI:1932834082
Name:MAIN LINE FERTILITY CLINIC PC
Entity Type:Organization
Organization Name:MAIN LINE FERTILITY CLINIC PC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:REVENUE CYCLE MGR
Authorized Official - Prefix:
Authorized Official - First Name:LISA
Authorized Official - Middle Name:
Authorized Official - Last Name:PEARSON
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:267-843-0767
Mailing Address - Street 1:4828 LOOP CENTRAL DR STE 900
Mailing Address - Street 2:
Mailing Address - City:HOUSTON
Mailing Address - State:TX
Mailing Address - Zip Code:77081-2220
Mailing Address - Country:US
Mailing Address - Phone:484-645-9700
Mailing Address - Fax:
Practice Address - Street 1:825 OLD LANCASTER RD STE 170
Practice Address - Street 2:
Practice Address - City:BRYN MAWR
Practice Address - State:PA
Practice Address - Zip Code:19010-3234
Practice Address - Country:US
Practice Address - Phone:610-527-0800
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2022-07-22
Last Update Date:2023-10-31
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207VE0102XAllopathic & Osteopathic PhysiciansObstetrics & GynecologyReproductive EndocrinologyGroup - Single Specialty