Provider Demographics
NPI:1245314319
Name:GYNEKON PLC
Entity type:Organization
Organization Name:GYNEKON PLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:MEMBER
Authorized Official - Prefix:
Authorized Official - First Name:ROZANNE
Authorized Official - Middle Name:GENYVE EVINDA
Authorized Official - Last Name:BENTT
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:703-822-9370
Mailing Address - Street 1:PO BOX 751916
Mailing Address - Street 2:
Mailing Address - City:LAS VEGAS
Mailing Address - State:NV
Mailing Address - Zip Code:89136-1916
Mailing Address - Country:US
Mailing Address - Phone:703-822-9370
Mailing Address - Fax:
Practice Address - Street 1:6355 WALKER LN
Practice Address - Street 2:SUITE 500
Practice Address - City:ALEXANDRIA
Practice Address - State:VA
Practice Address - Zip Code:22310-3245
Practice Address - Country:US
Practice Address - Phone:703-822-9370
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-10-25
Last Update Date:2007-12-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MDD0059703207VG0400X
VA0101046449207VG0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207VG0400XAllopathic & Osteopathic PhysiciansObstetrics & GynecologyGynecologyGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
F42696Medicare UPIN