Provider Demographics
NPI:1376071951
Name:MID-ATLANTIC WOMENS CARE PLC
Entity Type:Organization
Organization Name:MID-ATLANTIC WOMENS CARE PLC
Other - Org Name:WOMEN'S EXECUTIVE HEALTHCARE, P.C.
Other - Org Type:Doing Business As
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:DRINA
Authorized Official - Middle Name:A
Authorized Official - Last Name:NORTHAM
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:757-592-9600
Mailing Address - Street 1:11747 JEFFERSON AVE STE 1A
Mailing Address - Street 2:
Mailing Address - City:NEWPORT NEWS
Mailing Address - State:VA
Mailing Address - Zip Code:23606-4401
Mailing Address - Country:US
Mailing Address - Phone:757-592-9600
Mailing Address - Fax:
Practice Address - Street 1:11747 JEFFERSON AVE STE 1A
Practice Address - Street 2:
Practice Address - City:NEWPORT NEWS
Practice Address - State:VA
Practice Address - Zip Code:23606-4401
Practice Address - Country:US
Practice Address - Phone:757-592-9600
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:MID-ATLANTIC WOMENS CARE PLC
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2017-05-26
Last Update Date:2018-01-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207V00000XAllopathic & Osteopathic PhysiciansObstetrics & GynecologyGroup - Single Specialty