Provider Demographics
NPI:1396188579
Name:CENTER FOR CONTINENCE AND PELVIC SUPPORT PC
Entity Type:Organization
Organization Name:CENTER FOR CONTINENCE AND PELVIC SUPPORT PC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:JEFFREY
Authorized Official - Middle Name:ALAN
Authorized Official - Last Name:WELGOSS
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:703-698-7100
Mailing Address - Street 1:3289 WOODBURN RD
Mailing Address - Street 2:STE 130
Mailing Address - City:ANNANDALE
Mailing Address - State:VA
Mailing Address - Zip Code:22003-6800
Mailing Address - Country:US
Mailing Address - Phone:703-698-7100
Mailing Address - Fax:703-698-0073
Practice Address - Street 1:10215 FERNWOOD RD
Practice Address - Street 2:STE 300
Practice Address - City:BETHESDA
Practice Address - State:MD
Practice Address - Zip Code:20817-1106
Practice Address - Country:US
Practice Address - Phone:703-698-7100
Practice Address - Fax:703-698-0073
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2013-04-08
Last Update Date:2013-04-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes174400000XOther Service ProvidersSpecialistGroup - Single Specialty