Healthcare Provider Details

I. General information

NPI: 1003078403
Provider Name (Legal Business Name): REPROSOURCE FERTILITY DIAGNOSTICS, INC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 06/26/2008
Last Update Date: 09/02/2026
Certification Date: 09/02/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

200 FOREST STREET 2ND FLOOR, SUITE B
MARLBOROUGH MA
01752-3023
US

IV. Provider business mailing address

4770 REGENT BLVD
IRVING TX
75063-2445
US

V. Phone/Fax

Practice location:
  • Phone: 800-667-8893
  • Fax: 781-935-3068
Mailing address:
  • Phone: 866-697-8378
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code291U00000X
TaxonomyClinical Medical Laboratory
License Number2554
License Number StateMA

VIII. Authorized Official

Name: LEAH D TIMMERMAN
Title or Position: VICE PRESIDENT
Credential:
Phone: 973-520-2700