Provider Demographics
NPI:1245412048
Name:MOUNTAIN VIEW MIDWIFERY
Entity Type:Organization
Organization Name:MOUNTAIN VIEW MIDWIFERY
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PARTNER
Authorized Official - Prefix:DR
Authorized Official - First Name:DEREN
Authorized Official - Middle Name:ELAINE
Authorized Official - Last Name:BADER
Authorized Official - Suffix:
Authorized Official - Credentials:CPM, DRPH
Authorized Official - Phone:434-962-0148
Mailing Address - Street 1:1208 BLAND CIRCLE
Mailing Address - Street 2:
Mailing Address - City:CHARLOTTESVILLE
Mailing Address - State:VA
Mailing Address - Zip Code:22901
Mailing Address - Country:US
Mailing Address - Phone:434-962-0148
Mailing Address - Fax:703-564-8562
Practice Address - Street 1:1208 BLAND CIR
Practice Address - Street 2:
Practice Address - City:CHARLOTTESVILLE
Practice Address - State:VA
Practice Address - Zip Code:22901-4115
Practice Address - Country:US
Practice Address - Phone:434-962-0148
Practice Address - Fax:703-564-8562
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-12-04
Last Update Date:2007-12-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA176B00000X, 176B00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes176B00000XOther Service ProvidersMidwifeGroup - Single Specialty