Provider Demographics
NPI:1073697538
Name:A WOMAN'S PLACE OBGYN ASSOCIATES PC
Entity Type:Organization
Organization Name:A WOMAN'S PLACE OBGYN ASSOCIATES PC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:JILL
Authorized Official - Middle Name:T
Authorized Official - Last Name:SNYDER
Authorized Official - Suffix:
Authorized Official - Credentials:DO
Authorized Official - Phone:570-450-6454
Mailing Address - Street 1:668 N CHURCH ST
Mailing Address - Street 2:SUITE 20
Mailing Address - City:HAZLETON
Mailing Address - State:PA
Mailing Address - Zip Code:18201-3194
Mailing Address - Country:US
Mailing Address - Phone:570-450-6454
Mailing Address - Fax:570-450-2048
Practice Address - Street 1:668 N CHURCH ST
Practice Address - Street 2:SUITE 20
Practice Address - City:HAZLETON
Practice Address - State:PA
Practice Address - Zip Code:18201-3194
Practice Address - Country:US
Practice Address - Phone:570-450-6454
Practice Address - Fax:570-450-2048
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-10-24
Last Update Date:2009-09-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PAOS009234L207V00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207V00000XAllopathic & Osteopathic PhysiciansObstetrics & GynecologyGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
PAH22209Medicare UPIN
PAAW071058Medicare ID - Type Unspecified