Provider Demographics
NPI:1871509612
Name:MONARCH WOMEN'S WELLNESS, P.C
Entity Type:Organization
Organization Name:MONARCH WOMEN'S WELLNESS, P.C
Other - Org Name:CHURCHLAND OBSTETRICS AND GYNECOLOGY, P.C.
Other - Org Type:Former Legal Business Name
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:REBECCA
Authorized Official - Middle Name:B
Authorized Official - Last Name:THIBODEAU
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:757-673-8383
Mailing Address - Street 1:3802 POPLAR HILL RD
Mailing Address - Street 2:SUITE C
Mailing Address - City:CHESAPEAKE
Mailing Address - State:VA
Mailing Address - Zip Code:23321-5531
Mailing Address - Country:US
Mailing Address - Phone:757-673-8383
Mailing Address - Fax:757-483-9350
Practice Address - Street 1:3802 POPLAR HILL RD
Practice Address - Street 2:SUITE C
Practice Address - City:CHESAPEAKE
Practice Address - State:VA
Practice Address - Zip Code:23321-5531
Practice Address - Country:US
Practice Address - Phone:757-673-8383
Practice Address - Fax:757-483-9350
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-08-01
Last Update Date:2011-06-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207V00000XAllopathic & Osteopathic PhysiciansObstetrics & GynecologyGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
VA1871509612Medicaid
VAC05605Medicare PIN
VA1287320001Medicare NSC