Provider Demographics
NPI:1073583415
Name:A WOMENS CARE OB-GYN PC
Entity Type:Organization
Organization Name:A WOMENS CARE OB-GYN PC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:ILENE
Authorized Official - Middle Name:
Authorized Official - Last Name:WEIZER
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:570-628-4200
Mailing Address - Street 1:541 W BACON ST
Mailing Address - Street 2:
Mailing Address - City:POTTSVILLE
Mailing Address - State:PA
Mailing Address - Zip Code:17901-3917
Mailing Address - Country:US
Mailing Address - Phone:570-628-4200
Mailing Address - Fax:570-628-4824
Practice Address - Street 1:541 W BACON ST
Practice Address - Street 2:
Practice Address - City:POTTSVILLE
Practice Address - State:PA
Practice Address - Zip Code:17901-3917
Practice Address - Country:US
Practice Address - Phone:570-628-4200
Practice Address - Fax:570-628-4824
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-01-26
Last Update Date:2015-03-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207V00000XAllopathic & Osteopathic PhysiciansObstetrics & GynecologyGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
PA1007545770005Medicaid
PACK8371OtherTRAVELERS MEDICARE
1347147OtherHIGHMARK BS
1347147OtherHIGHMARK BS