Provider Demographics
NPI:1710942503
Name:NORTHWESTERN OBSTETRICS & GYNECOLOGY, P.A.
Entity Type:Organization
Organization Name:NORTHWESTERN OBSTETRICS & GYNECOLOGY, P.A.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:JOHN
Authorized Official - Middle Name:R
Authorized Official - Last Name:MARCHESE
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:828-264-9067
Mailing Address - Street 1:166 DOCTORS DR
Mailing Address - Street 2:
Mailing Address - City:BOONE
Mailing Address - State:NC
Mailing Address - Zip Code:28607-5000
Mailing Address - Country:US
Mailing Address - Phone:828-264-9067
Mailing Address - Fax:828-264-9068
Practice Address - Street 1:166 DOCTORS DR
Practice Address - Street 2:
Practice Address - City:BOONE
Practice Address - State:NC
Practice Address - Zip Code:28607-5000
Practice Address - Country:US
Practice Address - Phone:828-264-9067
Practice Address - Fax:828-264-9068
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-04-18
Last Update Date:2022-07-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC39517173000000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes173000000XOther Service ProvidersLegal MedicineGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
NC8902892Medicaid
NC8902892Medicaid