Provider Demographics
NPI:1699202523
Name:ADVANCED WOMEN'S HEALTH, LLC
Entity Type:Organization
Organization Name:ADVANCED WOMEN'S HEALTH, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:MANAGING MEMBER
Authorized Official - Prefix:DR
Authorized Official - First Name:MARYAM
Authorized Official - Middle Name:
Authorized Official - Last Name:AWAN
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:443-907-3312
Mailing Address - Street 1:7 POWELL PL
Mailing Address - Street 2:
Mailing Address - City:ELKTON
Mailing Address - State:MD
Mailing Address - Zip Code:21921-5175
Mailing Address - Country:US
Mailing Address - Phone:443-907-3312
Mailing Address - Fax:410-638-2680
Practice Address - Street 1:2 COLGATE DR STE 202
Practice Address - Street 2:
Practice Address - City:FOREST HILL
Practice Address - State:MD
Practice Address - Zip Code:21050-2616
Practice Address - Country:US
Practice Address - Phone:410-838-2000
Practice Address - Fax:410-638-2680
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2017-05-23
Last Update Date:2017-05-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207V00000XAllopathic & Osteopathic PhysiciansObstetrics & GynecologyGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
MD1932387578Medicaid