Provider Demographics
NPI:1215376025
Name:GYNE HEALTH OBSTETRICS & GYNECOLOGY LLC
Entity Type:Organization
Organization Name:GYNE HEALTH OBSTETRICS & GYNECOLOGY LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:DIRECTOR
Authorized Official - Prefix:DR
Authorized Official - First Name:ETEAKAMBA
Authorized Official - Middle Name:
Authorized Official - Last Name:UDOH
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:401-419-5998
Mailing Address - Street 1:9202 SILVEROSE CT
Mailing Address - Street 2:
Mailing Address - City:FAIRFAX STATION
Mailing Address - State:VA
Mailing Address - Zip Code:22039-3116
Mailing Address - Country:US
Mailing Address - Phone:401-419-5998
Mailing Address - Fax:
Practice Address - Street 1:2807 DUKE ST
Practice Address - Street 2:
Practice Address - City:ALEXANDRIA
Practice Address - State:VA
Practice Address - Zip Code:22314-4512
Practice Address - Country:US
Practice Address - Phone:401-419-5998
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2013-06-14
Last Update Date:2013-06-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA0101244682207V00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207V00000XAllopathic & Osteopathic PhysiciansObstetrics & GynecologyGroup - Single Specialty