Healthcare Provider Details

I. General information

NPI: 1851445563
Provider Name (Legal Business Name): FERTILITY CENTER OF MARYLAND
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 01/22/2007
Last Update Date: 08/22/2020
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

110 WEST ROAD SUITE 102
TOWSON MD
21204
US

IV. Provider business mailing address

110 WEST ROAD SUITE 102
TOWSON MD
21204
US

V. Phone/Fax

Practice location:
  • Phone: 410-296-6403
  • Fax: 410-296-6405
Mailing address:
  • Phone: 410-296-6403
  • Fax: 410-296-6405

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code163WR1000X
TaxonomyReproductive Endocrinology/Infertility Registered Nurse
License NumberD0035237
License Number StateMD

VIII. Authorized Official

Name: DR. SANTIAGO LUIS PADILIA
Title or Position: PRESIDENT
Credential: MD
Phone: 410-296-5400