Provider Demographics
NPI:1275571101
Name:MID-ATLANTIC WOMENS CARE
Entity Type:Organization
Organization Name:MID-ATLANTIC WOMENS CARE
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:SUSAN
Authorized Official - Middle Name:
Authorized Official - Last Name:LONTKOWSKI
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:757-253-5600
Mailing Address - Street 1:120 KINGS WAY
Mailing Address - Street 2:SUITE 3400
Mailing Address - City:WILLIAMSBURG
Mailing Address - State:VA
Mailing Address - Zip Code:23185-2505
Mailing Address - Country:US
Mailing Address - Phone:757-253-5600
Mailing Address - Fax:757-253-0819
Practice Address - Street 1:120 KINGS WAY
Practice Address - Street 2:SUITE 3400
Practice Address - City:WILLIAMSBURG
Practice Address - State:VA
Practice Address - Zip Code:23185-2505
Practice Address - Country:US
Practice Address - Phone:757-253-5600
Practice Address - Fax:757-253-0819
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:MID-ATLANTIC WOMENS CARE PLC
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2006-06-03
Last Update Date:2018-01-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207V00000XAllopathic & Osteopathic PhysiciansObstetrics & GynecologyGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
VA6200419Medicaid
VA6208819Medicaid
VA010270405Medicaid
VA160001310Medicaid
VA6208851Medicaid
VA6208835Medicaid
VA6216544Medicaid