Provider Demographics
NPI:1407194186
Name:CENTER FOR CONTINENCE AND PELVIC SUPPORT PC
Entity Type:Organization
Organization Name:CENTER FOR CONTINENCE AND PELVIC SUPPORT PC
Other - Org Name:CENTER FOR UROGYNECOLOGY AND PELVIC SURGERY
Other - Org Type:Doing Business As
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:571-389-7140
Mailing Address - Street 1:3289 WOODBURN RD
Mailing Address - Street 2:SUITE 130
Mailing Address - City:ANNANDALE
Mailing Address - State:VA
Mailing Address - Zip Code:22003-6800
Mailing Address - Country:US
Mailing Address - Phone:571-389-7140
Mailing Address - Fax:703-992-7584
Practice Address - Street 1:3289 WOODBURN RD
Practice Address - Street 2:SUITE 130
Practice Address - City:ANNANDALE
Practice Address - State:VA
Practice Address - Zip Code:22003-6800
Practice Address - Country:US
Practice Address - Phone:571-389-7140
Practice Address - Fax:703-992-7584
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2013-01-30
Last Update Date:2013-11-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207VF0040XAllopathic & Osteopathic PhysiciansObstetrics & GynecologyFemale Pelvic Medicine and Reconstructive SurgeryGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
VA271520OtherMEDICARE - GROUP PTAN