1063557098 NPI number — MID-ATLANTIC WOMENS CARE PLC

Table of Contents

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1063557098 NPI number — MID-ATLANTIC WOMENS CARE PLC

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
MID-ATLANTIC WOMENS CARE PLC
Provider Last Name:
Provider First Name:
Provider Middle Name:
Provider Name Prefix Text:
Provider Name Suffix Text:
Provider Credential Text:
Provider Gender Code:

Provider's Other Name Information

Provider Other Organization Name:
VIRGINIA CENTER FOR WOMEN
Provider Other Organization Name Type Code:
3
Provider Other Last Name:
Provider Other First Name:
Provider Other Middle Name:
Provider Other Name Prefix Text:
Provider Other Name Suffix Text:
Provider Other Credential Text:
Provider Other Last Name Type Code:

NPI Number Information

NPI Number:
1063557098
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
03/17/2018
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
1101 MADISON PLZ
Provider Second Line Business Mailing Address:
SUITE 201
Provider Business Mailing Address City Name:
CHESAPEAKE
Provider Business Mailing Address State Name:
VA
Provider Business Mailing Address Postal Code:
23320-5179
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
757-547-2322
Provider Business Mailing Address Fax Number:
757-547-9439

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
1101 MADISON PLZ
Provider Second Line Business Practice Location Address:
SUITE 201
Provider Business Practice Location Address City Name:
CHESAPEAKE
Provider Business Practice Location Address State Name:
VA
Provider Business Practice Location Address Postal Code:
23320-5179
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
757-547-2322
Provider Business Practice Location Address Fax Number:
757-547-9439
Provider Enumeration Date:
02/20/2007

Additional Information

Authorized Official

Authorized Official Last Name:
GRAY
Authorized Official First Name:
DERWIN
Authorized Official Middle Name:
Authorized Official Title or Position:
PRESIDENT
Authorized Official Telephone Number:
757-547-2322

Provider Taxonomy Codes

  • Taxonomy code: 207V00000X ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

Other Provider's Identifiers (legacy, non-NPI)





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