Provider Demographics
NPI:1518158898
Name:VILLAGE OB GYN ASSOCIATES, LLC
Entity Type:Organization
Organization Name:VILLAGE OB GYN ASSOCIATES, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:MANAGING PARTNER
Authorized Official - Prefix:DR
Authorized Official - First Name:JOEL
Authorized Official - Middle Name:FRANKLIN
Authorized Official - Last Name:PLEETER
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:410-653-6500
Mailing Address - Street 1:37 WALKER AVE
Mailing Address - Street 2:
Mailing Address - City:PIKESVILLE
Mailing Address - State:MD
Mailing Address - Zip Code:21208-4004
Mailing Address - Country:US
Mailing Address - Phone:410-653-6500
Mailing Address - Fax:410-653-6511
Practice Address - Street 1:37 WALKER AVE
Practice Address - Street 2:
Practice Address - City:PIKESVILLE
Practice Address - State:MD
Practice Address - Zip Code:21208-4004
Practice Address - Country:US
Practice Address - Phone:410-653-6500
Practice Address - Fax:410-653-6511
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-08-05
Last Update Date:2007-08-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MDD46131174400000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes174400000XOther Service ProvidersSpecialistGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
MDF98577Medicare UPIN