Organization
SHADY GROVE ANDROLOGY CENTER LLC
Active
Organization
SHADY GROVE ANDROLOGY CENTER LLC
Active
Parent organization
SHADY GROVE FERTILITY RSC
Other names
Michael J. Tucker, PhD
Organization subpart
Yes
Provider details
NPI number
Legal business name
SHADY GROVE FERTILITY RSC
Authorized official
SHELLY SHAPIRO (CHIEF FINANCIAL OFFICER)
(301) 545-1407
Entity
Organization
Contact information
Practice address
9600 BLACKWELL RD STE 500, ROCKVILLE, MD 20850-3783
(301) 340-1188
(301) 340-1612
Mailing address
9600 BLACKWELL RD STE 500, ROCKVILLE, MD 20850-3783
(301) 340-1188
(301) 340-1612
Taxonomy
Speciality
Code
Description
License number
State
291U00000X
Clinical Medical Laboratory
7629
MO
291U00000X
Clinical Medical Laboratory
Primary
—
—
Other
Enumeration date
04/04/2007
Last updated
03/30/2018
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