Healthcare Provider Details

I. General information

NPI: 1679348916
Provider Name (Legal Business Name): RADIANCE FERTILITY PC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 11/16/2023
Last Update Date: 01/23/2024
Certification Date: 01/23/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

910 SHERATON DR FL 4
MARS PA
16046-9432
US

IV. Provider business mailing address

801 ONEIDA CIR
MARS PA
16046-4041
US

V. Phone/Fax

Practice location:
  • Phone: 412-722-8820
  • Fax:
Mailing address:
  • Phone: 412-722-8820
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

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

VII. Legacy identifiers

For crosswalk purposes, the following legacy (non-NPI) identifiers are available for this provider:

# 1
IdentifierMD427080
Identifier TypeOTHER
Identifier StatePA
Identifier IssuerMEDICAL LICENSE

VIII. Authorized Official

Name: DR. SUNITA KATARI
Title or Position: SECRETARY
Credential: MD
Phone: 412-722-8820