Healthcare Provider Details

I. General information

NPI: 1134605009
Provider Name (Legal Business Name): THE CENTER FOR CONCEPTION AND PELVIC SURGERY, INC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 07/13/2018
Last Update Date: 08/28/2018
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3202 TOWER OAKS BLVD STE 370B
ROCKVILLE MD
20852
US

IV. Provider business mailing address

3202 TOWER OAKS BLVD STE 370B
ROCKVILLE MD
20852-4219
US

V. Phone/Fax

Practice location:
  • Phone: 301-442-8548
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code261QA1903X
TaxonomyAmbulatory Surgical Clinic/Center
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code261QR0200X
TaxonomyRadiology Clinic/Center
License Number
License Number State
# 3
Primary TaxonomyN
Taxonomy Code291U00000X
TaxonomyClinical Medical Laboratory
License Number
License Number State

VIII. Authorized Official

Name: DR. OLUYEMISI FAMUYIIWA
Title or Position: DIRECTOR
Credential: MD
Phone: 301-442-8548