Provider Demographics
NPI:1093324162
Name:EVOSCIENT GYNECOLOGY CENTER FOR PELVIC HEALTH AND SURGERY, PC
Entity Type:Organization
Organization Name:EVOSCIENT GYNECOLOGY CENTER FOR PELVIC HEALTH AND SURGERY, PC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:MARY
Authorized Official - Middle Name:NDIDI-EGBUNIWE
Authorized Official - Last Name:OJO-CARONS
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:757-473-2021
Mailing Address - Street 1:700 INDEPENDENCE CIR STE 2A
Mailing Address - Street 2:
Mailing Address - City:VIRGINIA BEACH
Mailing Address - State:VA
Mailing Address - Zip Code:23455-6405
Mailing Address - Country:US
Mailing Address - Phone:757-473-2021
Mailing Address - Fax:757-518-1110
Practice Address - Street 1:700 INDEPENDENCE CIR STE 2A
Practice Address - Street 2:
Practice Address - City:VIRGINIA BEACH
Practice Address - State:VA
Practice Address - Zip Code:23455-6405
Practice Address - Country:US
Practice Address - Phone:757-473-2021
Practice Address - Fax:757-518-1110
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2020-07-24
Last Update Date:2020-12-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207VG0400XAllopathic & Osteopathic PhysiciansObstetrics & GynecologyGynecologyGroup - Multi-Specialty
No207V00000XAllopathic & Osteopathic PhysiciansObstetrics & GynecologyGroup - Multi-Specialty
No207VF0040XAllopathic & Osteopathic PhysiciansObstetrics & GynecologyFemale Pelvic Medicine and Reconstructive SurgeryGroup - Multi-Specialty
No225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical TherapistGroup - Multi-Specialty