Provider Demographics
NPI:1346201662
Name:OBSTETRICS & GYNECOLOGY OF WASHINGTON
Entity Type:Organization
Organization Name:OBSTETRICS & GYNECOLOGY OF WASHINGTON
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OFFICE MANAGER
Authorized Official - Prefix:MRS
Authorized Official - First Name:CAMILLE
Authorized Official - Middle Name:
Authorized Official - Last Name:NORRIS
Authorized Official - Suffix:
Authorized Official - Credentials:CPC
Authorized Official - Phone:252-940-6160
Mailing Address - Street 1:1210 N BROWN ST
Mailing Address - Street 2:
Mailing Address - City:WASHINGTON
Mailing Address - State:NC
Mailing Address - Zip Code:27889-4671
Mailing Address - Country:US
Mailing Address - Phone:252-940-6160
Mailing Address - Fax:252-975-3800
Practice Address - Street 1:1210 N BROWN ST
Practice Address - Street 2:
Practice Address - City:WASHINGTON
Practice Address - State:NC
Practice Address - Zip Code:27889-4671
Practice Address - Country:US
Practice Address - Phone:252-940-6160
Practice Address - Fax:252-975-3800
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-03-28
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207V00000XAllopathic & Osteopathic PhysiciansObstetrics & GynecologyGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
NC890136GMedicaid
NC=========OtherTAX ID
NC2344045Medicare ID - Type UnspecifiedCARE GRP NUMBER