Provider Demographics
NPI:1013930981
Name:WOMENS CENTER OB GYN ASSOC LLC
Entity Type:Organization
Organization Name:WOMENS CENTER OB GYN ASSOC LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OFFICE MANAGER
Authorized Official - Prefix:
Authorized Official - First Name:MARY
Authorized Official - Middle Name:C
Authorized Official - Last Name:PATAKI
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:410-465-4690
Mailing Address - Street 1:3454 ELLICOTT CENTER DR
Mailing Address - Street 2:SUITE 103
Mailing Address - City:ELLICOTT CITY
Mailing Address - State:MD
Mailing Address - Zip Code:21043-4113
Mailing Address - Country:US
Mailing Address - Phone:410-465-4690
Mailing Address - Fax:410-465-8144
Practice Address - Street 1:3454 ELLICOTT CENTER DR
Practice Address - Street 2:SUITE 103
Practice Address - City:ELLICOTT CITY
Practice Address - State:MD
Practice Address - Zip Code:21043-4113
Practice Address - Country:US
Practice Address - Phone:410-465-4690
Practice Address - Fax:410-465-8144
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-07-25
Last Update Date:2008-05-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MD207V00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207V00000XAllopathic & Osteopathic PhysiciansObstetrics & GynecologyGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
MD245LMedicare PIN