Provider Demographics
NPI:1851336267
Name:GREENBRIER OBSTETRICS AND GYNECOLOGY, P. C.
Entity Type:Organization
Organization Name:GREENBRIER OBSTETRICS AND GYNECOLOGY, P. C.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:MATTHEW
Authorized Official - Middle Name:
Authorized Official - Last Name:WHITTED
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:757-547-4500
Mailing Address - Street 1:713 VOLVO PKWY
Mailing Address - Street 2:STE 200
Mailing Address - City:CHESAPEAKE
Mailing Address - State:VA
Mailing Address - Zip Code:23320-1614
Mailing Address - Country:US
Mailing Address - Phone:757-547-4500
Mailing Address - Fax:757-547-4502
Practice Address - Street 1:713 VOLVO PKWY
Practice Address - Street 2:STE 200
Practice Address - City:CHESAPEAKE
Practice Address - State:VA
Practice Address - Zip Code:23320-1614
Practice Address - Country:US
Practice Address - Phone:757-547-4500
Practice Address - Fax:757-547-4502
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-06-19
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA0101044724207V00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207V00000XAllopathic & Osteopathic PhysiciansObstetrics & GynecologyGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
VA006202152Medicaid