Provider Demographics
NPI:1780824953
Name:MID-ATLANTIC WOMENS CARE PLC
Entity Type:Organization
Organization Name:MID-ATLANTIC WOMENS CARE PLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:DERWIN
Authorized Official - Middle Name:
Authorized Official - Last Name:GRAY
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:757-547-2322
Mailing Address - Street 1:4917 S CROATAN HWY
Mailing Address - Street 2:
Mailing Address - City:NAGS HEAD
Mailing Address - State:NC
Mailing Address - Zip Code:27959-8811
Mailing Address - Country:US
Mailing Address - Phone:252-449-2100
Mailing Address - Fax:252-449-2157
Practice Address - Street 1:4917 S CROATAN HWY
Practice Address - Street 2:
Practice Address - City:NAGS HEAD
Practice Address - State:NC
Practice Address - Zip Code:27959-8811
Practice Address - Country:US
Practice Address - Phone:252-449-2100
Practice Address - Fax:252-449-2157
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:MID-ATLANTIC WOMENS CARE PLC
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2009-03-02
Last Update Date:2018-01-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes174400000XOther Service ProvidersSpecialistGroup - Single Specialty