Provider Demographics
NPI:1568591964
Name:WHOLE WOMAN'S HEALTH OF BALTIMORE LLC
Entity Type:Organization
Organization Name:WHOLE WOMAN'S HEALTH OF BALTIMORE LLC
Other - Org Name:WHOLE WOMAN'S HEALTH OF BALTIMORE
Other - Org Type:Other Name
Authorized Official - Title/Position:CEO
Authorized Official - Prefix:
Authorized Official - First Name:AMY
Authorized Official - Middle Name:
Authorized Official - Last Name:HAGSTROM MILLER
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:512-835-6691
Mailing Address - Street 1:1001 E MARKET ST STE 200
Mailing Address - Street 2:
Mailing Address - City:CHARLOTTESVILLE
Mailing Address - State:VA
Mailing Address - Zip Code:22902-5381
Mailing Address - Country:US
Mailing Address - Phone:512-835-6858
Mailing Address - Fax:410-661-2259
Practice Address - Street 1:7648 BELAIR RD
Practice Address - Street 2:
Practice Address - City:BALTIMORE
Practice Address - State:MD
Practice Address - Zip Code:21236-4088
Practice Address - Country:US
Practice Address - Phone:410-661-2900
Practice Address - Fax:410-661-2259
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-03-04
Last Update Date:2020-01-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207V00000XAllopathic & Osteopathic PhysiciansObstetrics & GynecologyGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
MD409285600Medicaid