Provider Demographics
NPI:1851339246
Name:MID-ATLANTIC WOMENS CARE PLC
Entity Type:Organization
Organization Name:MID-ATLANTIC WOMENS CARE PLC
Other - Org Name:COMPLETE WOMENS CARE
Other - Org Type:Doing Business As
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:TRACY
Authorized Official - Middle Name:
Authorized Official - Last Name:WRIGHT
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:757-481-7222
Mailing Address - Street 1:1080 FIRST COLONIAL RD STE 300
Mailing Address - Street 2:
Mailing Address - City:VIRGINIA BEACH
Mailing Address - State:VA
Mailing Address - Zip Code:23454-2406
Mailing Address - Country:US
Mailing Address - Phone:757-481-7222
Mailing Address - Fax:757-496-3772
Practice Address - Street 1:1080 FIRST COLONIAL RD
Practice Address - Street 2:SUITE 300
Practice Address - City:VIRGINIA BEACH
Practice Address - State:VA
Practice Address - Zip Code:23454-2406
Practice Address - Country:US
Practice Address - Phone:757-481-7222
Practice Address - Fax:757-496-3772
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:MID-ATLANTIC WOMENS CARE PLC
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2006-06-04
Last Update Date:2018-03-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207V00000XAllopathic & Osteopathic PhysiciansObstetrics & GynecologyGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
VA6208509Medicaid
VA6208509Medicaid
VACB2846Medicare PIN