Provider Demographics
NPI:1316069115
Name:SHADY GROVE CENTER FOR PREIMPLANTATION GENETICS
Entity type:Organization
Organization Name:SHADY GROVE CENTER FOR PREIMPLANTATION GENETICS
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:DIRECTOR
Authorized Official - Prefix:
Authorized Official - First Name:WILLIAM
Authorized Official - Middle Name:
Authorized Official - Last Name:KEARNS
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:301-340-1188
Mailing Address - Street 1:15001 SHADY GROVE RD
Mailing Address - Street 2:SUITE 220
Mailing Address - City:ROCKVILLE
Mailing Address - State:MD
Mailing Address - Zip Code:20850-6352
Mailing Address - Country:US
Mailing Address - Phone:301-340-1188
Mailing Address - Fax:301-340-6478
Practice Address - Street 1:15001 SHADY GROVE RD
Practice Address - Street 2:SUITE 220
Practice Address - City:ROCKVILLE
Practice Address - State:MD
Practice Address - Zip Code:20850-6352
Practice Address - Country:US
Practice Address - Phone:301-340-1188
Practice Address - Fax:301-340-6478
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-04-04
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MD1107291U00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes291U00000XLaboratoriesClinical Medical Laboratory