Provider Demographics
NPI:1376769323
Name:MID-ATLANTIC WOMENS CARE PLC
Entity Type:Organization
Organization Name:MID-ATLANTIC WOMENS CARE PLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:DIRECTOR
Authorized Official - Prefix:
Authorized Official - First Name:IVAN
Authorized Official - Middle Name:KENNETH
Authorized Official - Last Name:MUHLENDORF
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:757-461-6131
Mailing Address - Street 1:420 N CENTER DR
Mailing Address - Street 2:SUITE 203
Mailing Address - City:NORFOLK
Mailing Address - State:VA
Mailing Address - Zip Code:23502-4007
Mailing Address - Country:US
Mailing Address - Phone:757-455-8833
Mailing Address - Fax:757-962-2420
Practice Address - Street 1:844 KEMPSVILLE RD STE 210
Practice Address - Street 2:
Practice Address - City:NORFOLK
Practice Address - State:VA
Practice Address - Zip Code:23502-3927
Practice Address - Country:US
Practice Address - Phone:757-461-6131
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:MID-ATLANTIC WOMENS CARE PLC
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2007-04-18
Last Update Date:2018-03-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QR0206XAmbulatory Health Care FacilitiesClinic/CenterRadiology, Mammography
Provider Identifiers
StateIdentifier IDID TypeIssuer
190002027Medicare PIN