Provider Demographics
NPI:1952700015
Name:FERTILITY CENTER OF MARYLAND, PA
Entity Type:Organization
Organization Name:FERTILITY CENTER OF MARYLAND, PA
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:SANTIAGO
Authorized Official - Middle Name:LUIS
Authorized Official - Last Name:PADILLA
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:410-296-6400
Mailing Address - Street 1:110 WEST RD
Mailing Address - Street 2:SUITE 102
Mailing Address - City:TOWSON
Mailing Address - State:MD
Mailing Address - Zip Code:21204-2363
Mailing Address - Country:US
Mailing Address - Phone:410-296-6400
Mailing Address - Fax:410-296-6405
Practice Address - Street 1:110 WEST RD
Practice Address - Street 2:SUITE 102
Practice Address - City:TOWSON
Practice Address - State:MD
Practice Address - Zip Code:21204-2363
Practice Address - Country:US
Practice Address - Phone:410-296-6400
Practice Address - Fax:410-296-6405
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2014-08-14
Last Update Date:2014-08-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MDD0035237207VE0102X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207VE0102XAllopathic & Osteopathic PhysiciansObstetrics & GynecologyReproductive EndocrinologyGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
MDK867OtherMEDICARE ID
MDD76560Medicare UPIN