Provider Demographics
NPI:1093761686
Name:REGIONAL WOMENS HEALTH GROUP LLC
Entity Type:Organization
Organization Name:REGIONAL WOMENS HEALTH GROUP LLC
Other - Org Name:RWHG VIRTUA CENTER FOR WOMEN
Other - Org Type:Doing Business As
Authorized Official - Title/Position:VP, REV CYCLE
Authorized Official - Prefix:
Authorized Official - First Name:EDWARD
Authorized Official - Middle Name:C
Authorized Official - Last Name:DONOVAN
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:856-669-6050
Mailing Address - Street 1:PO BOX 71421
Mailing Address - Street 2:
Mailing Address - City:PHILADELPHIA
Mailing Address - State:PA
Mailing Address - Zip Code:19176-1421
Mailing Address - Country:US
Mailing Address - Phone:856-669-6050
Mailing Address - Fax:856-651-0794
Practice Address - Street 1:200 BOWMAN DR STE E340
Practice Address - Street 2:
Practice Address - City:VOORHEES
Practice Address - State:NJ
Practice Address - Zip Code:08043-9636
Practice Address - Country:US
Practice Address - Phone:856-247-7600
Practice Address - Fax:856-247-7575
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-05-25
Last Update Date:2020-11-05
Deactivation Date:2007-01-05
Deactivation Code:
Reactivation Date:2007-03-02
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207V00000XAllopathic & Osteopathic PhysiciansObstetrics & GynecologyGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
NJ8328706Medicaid
NJ8328706Medicaid