Provider Demographics
NPI:1053860999
Name:WOMEN'S HEALTHCARE GROUP OF PENNSYLVANIA LLC
Entity Type:Organization
Organization Name:WOMEN'S HEALTHCARE GROUP OF PENNSYLVANIA LLC
Other - Org Name:WHCGPA MAIN LINE OB/GYN
Other - Org Type:Doing Business As
Authorized Official - Title/Position:DIRECTOR OF CREDENTIALING
Authorized Official - Prefix:
Authorized Official - First Name:CATHY
Authorized Official - Middle Name:
Authorized Official - Last Name:IMBESI
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:610-482-4778
Mailing Address - Street 1:PO BOX 1109
Mailing Address - Street 2:
Mailing Address - City:OAKS
Mailing Address - State:PA
Mailing Address - Zip Code:19456-1109
Mailing Address - Country:US
Mailing Address - Phone:610-482-4778
Mailing Address - Fax:610-666-3310
Practice Address - Street 1:85 OLD EAGLE SCHOOL RD
Practice Address - Street 2:101
Practice Address - City:STRAFFORD
Practice Address - State:PA
Practice Address - Zip Code:19087-2556
Practice Address - Country:US
Practice Address - Phone:610-688-3744
Practice Address - Fax:610-688-4490
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2016-10-03
Last Update Date:2018-01-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PASP016409363LX0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes363LX0001XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerObstetrics & GynecologyGroup - Single Specialty