Provider Demographics
NPI:1629290275
Name:COMPLETE WOMENS CARE PC
Entity Type:Organization
Organization Name:COMPLETE WOMENS CARE PC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:DELEGATED OFFICIAL
Authorized Official - Prefix:
Authorized Official - First Name:DAVID
Authorized Official - Middle Name:B
Authorized Official - Last Name:KLEBANOFF
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:610-956-0003
Mailing Address - Street 1:1651 WEST FRONT STREET
Mailing Address - Street 2:
Mailing Address - City:BERWICK
Mailing Address - State:PA
Mailing Address - Zip Code:18603
Mailing Address - Country:US
Mailing Address - Phone:610-956-0003
Mailing Address - Fax:
Practice Address - Street 1:1650 HUNGTONDON PIKE
Practice Address - Street 2:
Practice Address - City:MEADOWBROOK
Practice Address - State:PA
Practice Address - Zip Code:19046
Practice Address - Country:US
Practice Address - Phone:610-956-0003
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-05-03
Last Update Date:2008-07-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PAMD027587E207VX0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207VX0000XAllopathic & Osteopathic PhysiciansObstetrics & GynecologyObstetricsGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
PA1019196900002Medicaid
PA1019196900002Medicaid