Provider Demographics
NPI:1013105667
Name:WOMENS HEALTH CARE OF DELMARVA PA
Entity type:Organization
Organization Name:WOMENS HEALTH CARE OF DELMARVA PA
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:ADMINISTRATOR
Authorized Official - Prefix:
Authorized Official - First Name:KENT
Authorized Official - Middle Name:
Authorized Official - Last Name:RILLING
Authorized Official - Suffix:
Authorized Official - Credentials:PA-C
Authorized Official - Phone:410-352-5527
Mailing Address - Street 1:659 S SALISBURY BLVD
Mailing Address - Street 2:
Mailing Address - City:SALISBURY
Mailing Address - State:MD
Mailing Address - Zip Code:21801-5453
Mailing Address - Country:US
Mailing Address - Phone:410-352-5527
Mailing Address - Fax:410-352-3024
Practice Address - Street 1:659 S SALISBURY BLVD
Practice Address - Street 2:
Practice Address - City:SALISBURY
Practice Address - State:MD
Practice Address - Zip Code:21801-5453
Practice Address - Country:US
Practice Address - Phone:410-352-5527
Practice Address - Fax:410-352-3024
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-10-09
Last Update Date:2018-06-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MDD0045108207V00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207V00000XAllopathic & Osteopathic PhysiciansObstetrics & GynecologyGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
=========OtherTAX ID#