Provider Demographics
NPI:1477652626
Name:MID-ATLANTIC WOMENS CARE PLC
Entity Type:Organization
Organization Name:MID-ATLANTIC WOMENS CARE PLC
Other - Org Name:WOMANCARE CENTERS PLC
Other - Org Type:Doing Business As
Authorized Official - Title/Position:PARTNER VICE PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:G.
Authorized Official - Middle Name:THEODORE
Authorized Official - Last Name:HUGHES
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:757-451-0929
Mailing Address - Street 1:100 KINGSLEY LN STE 200
Mailing Address - Street 2:
Mailing Address - City:NORFOLK
Mailing Address - State:VA
Mailing Address - Zip Code:23505-4604
Mailing Address - Country:US
Mailing Address - Phone:757-451-0929
Mailing Address - Fax:757-423-4901
Practice Address - Street 1:100 KINGSLEY LN STE 200
Practice Address - Street 2:
Practice Address - City:NORFOLK
Practice Address - State:VA
Practice Address - Zip Code:23505-4604
Practice Address - Country:US
Practice Address - Phone:757-451-0929
Practice Address - Fax:757-423-4901
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:MID-ATLANTIC WOMENS CARE PLC
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2006-09-22
Last Update Date:2018-01-31
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA207V00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207V00000XAllopathic & Osteopathic PhysiciansObstetrics & GynecologyGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
VA010064490Medicaid
VA010296757Medicaid
VA006208576Medicaid
VA006208584Medicaid
VA007790465Medicaid
VA007790571Medicaid
VAC05066Medicare ID - Type UnspecifiedWOMANCARE CENTERS, PLC
VAB09368Medicare UPIN
VA420000031Medicare ID - Type UnspecifiedBLAIR CONGER
VA007790465Medicaid
VA010296757Medicaid
VA160001350Medicare ID - Type UnspecifiedMARYBETH DIXON
VA160001352Medicare ID - Type UnspecifiedG. THEODORE HUGHES
VA420000029Medicare ID - Type UnspecifiedNELDARA DOWELL
VA011341M66Medicare ID - Type UnspecifiedERIN C SMITH
VAP11748Medicare UPIN
VA007790571Medicaid
VA006208576Medicaid
VA006208584Medicaid