Healthcare Provider Details

I. General information

NPI: 1922353366
Provider Name (Legal Business Name): SHADY GROVE FERTILITY CENTER OF PENNSYLVANIA PLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 07/23/2012
Last Update Date: 04/27/2023
Certification Date: 04/27/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

735 CHESTERBROOK BLVD SUITE 100
CHESTERBROOK PA
19087-5638
US

IV. Provider business mailing address

9600 BLACKWELL ROAD SUITE 500
ROCKVILLE MD
20850-3783
US

V. Phone/Fax

Practice location:
  • Phone: 610-981-6000
  • Fax: 855-437-5785
Mailing address:
  • Phone: 301-340-1188
  • Fax: 855-716-1603

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207VE0102X
TaxonomyReproductive Endocrinology Physician
License Number
License Number State

VIII. Authorized Official

Name: VICKI GERBER
Title or Position: EXECUTIVE MANAGING DIRECTOR
Credential:
Phone: 301-545-1248