Healthcare Provider Details

I. General information

NPI: 1598748139
Provider Name (Legal Business Name): VIRGINIA IVF & ANDROLOGY CENTER
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 11/29/2005
Last Update Date: 08/22/2020
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

9030 STONY POINT PKWY SUITE 390
RICHMOND VA
23235-1957
US

IV. Provider business mailing address

9030 STONY POINT PKWY SUITE 390
RICHMOND VA
23235-1957
US

V. Phone/Fax

Practice location:
  • Phone: 804-323-9980
  • Fax: 804-323-9979
Mailing address:
  • Phone: 804-323-9980
  • Fax: 804-323-9979

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code291U00000X
TaxonomyClinical Medical Laboratory
License Number
License Number StateVA

VIII. Authorized Official

Name: DR. DENNIS W MATT
Title or Position: SCIENTIFIC DIRECTOR
Credential: PHD, HCLD
Phone: 804-323-9980