Provider Demographics
NPI:1437476777
Name:THE CENTER FOR INNOVATIVE GYN CENTER, PC
Entity Type:Organization
Organization Name:THE CENTER FOR INNOVATIVE GYN CENTER, PC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:PAUL
Authorized Official - Middle Name:J
Authorized Official - Last Name:MACKOUL
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:301-404-6490
Mailing Address - Street 1:3206 TOWER OAKS BLVD STE 200
Mailing Address - Street 2:
Mailing Address - City:ROCKVILLE
Mailing Address - State:MD
Mailing Address - Zip Code:20852-4253
Mailing Address - Country:US
Mailing Address - Phone:301-652-4800
Mailing Address - Fax:301-664-6475
Practice Address - Street 1:3206 TOWER OAKS BLVD STE 200
Practice Address - Street 2:
Practice Address - City:ROCKVILLE
Practice Address - State:MD
Practice Address - Zip Code:20852-4253
Practice Address - Country:US
Practice Address - Phone:301-652-4800
Practice Address - Fax:301-664-6475
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2010-04-27
Last Update Date:2022-09-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207V00000XAllopathic & Osteopathic PhysiciansObstetrics & GynecologyGroup - Multi-Specialty