Provider Demographics
NPI:1902852528
Name:WOMENS HEALTH ALLIANCE PA
Entity Type:Organization
Organization Name:WOMENS HEALTH ALLIANCE PA
Other - Org Name:CAPITAL AREA OBGYN
Other - Org Type:Doing Business As
Authorized Official - Title/Position:DIRECTOR
Authorized Official - Prefix:MS
Authorized Official - First Name:JUDY
Authorized Official - Middle Name:H
Authorized Official - Last Name:GARRETT
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:919-848-4080
Mailing Address - Street 1:4414 LAKE BOONE TRAIL
Mailing Address - Street 2:# 308
Mailing Address - City:RALEIGH
Mailing Address - State:NC
Mailing Address - Zip Code:27607
Mailing Address - Country:US
Mailing Address - Phone:919-781-7450
Mailing Address - Fax:919-781-6355
Practice Address - Street 1:4414 LAKE BOONE TRL
Practice Address - Street 2:# 308
Practice Address - City:RALEIGH
Practice Address - State:NC
Practice Address - Zip Code:27607-7513
Practice Address - Country:US
Practice Address - Phone:919-781-7450
Practice Address - Fax:919-781-6355
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-05-25
Last Update Date:2008-06-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207V00000XAllopathic & Osteopathic PhysiciansObstetrics & GynecologyGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
NC01880OtherBCBS
NC8902002AMedicaid
NC01880OtherBCBS