Provider Demographics
NPI:1407115207
Name:STAFFORD WOMENS HEALTH ASSOCIATES
Entity Type:Organization
Organization Name:STAFFORD WOMENS HEALTH ASSOCIATES
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:MANAGER
Authorized Official - Prefix:
Authorized Official - First Name:LISA
Authorized Official - Middle Name:
Authorized Official - Last Name:DANIELSON
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:540-656-2804
Mailing Address - Street 1:1300 HOSPITAL DR
Mailing Address - Street 2:SUITE 300
Mailing Address - City:FREDERICKSBURG
Mailing Address - State:VA
Mailing Address - Zip Code:22401-8451
Mailing Address - Country:US
Mailing Address - Phone:540-656-2830
Mailing Address - Fax:540-656-2856
Practice Address - Street 1:125 HOSPITAL CENTER BLVD
Practice Address - Street 2:SUITE 313
Practice Address - City:STAFFORD
Practice Address - State:VA
Practice Address - Zip Code:22554-6202
Practice Address - Country:US
Practice Address - Phone:540-656-2830
Practice Address - Fax:540-656-2856
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2012-05-14
Last Update Date:2012-05-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA0101058318207V00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207V00000XAllopathic & Osteopathic PhysiciansObstetrics & GynecologyGroup - Single Specialty