Provider Demographics
NPI:1295163004
Name:JUST FOR WOMEN GYNECOLOGY , PA
Entity type:Organization
Organization Name:JUST FOR WOMEN GYNECOLOGY , PA
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PHYSICIAN
Authorized Official - Prefix:
Authorized Official - First Name:KATHLEEN
Authorized Official - Middle Name:CLAIRE
Authorized Official - Last Name:MORRIS
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:207-206-7270
Mailing Address - Street 1:462 MAIN ST STE 1
Mailing Address - Street 2:SPRINGVALE
Mailing Address - City:SPRINGVALE
Mailing Address - State:ME
Mailing Address - Zip Code:04083-1818
Mailing Address - Country:US
Mailing Address - Phone:207-206-7270
Mailing Address - Fax:
Practice Address - Street 1:462 MAIN ST STE 1
Practice Address - Street 2:SPRINGVALE
Practice Address - City:SPRINGVALE
Practice Address - State:ME
Practice Address - Zip Code:04083-1818
Practice Address - Country:US
Practice Address - Phone:207-206-7270
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2013-10-15
Last Update Date:2014-05-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MEMD012728207VG0400X
MEMD11910207VG0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207VG0400XAllopathic & Osteopathic PhysiciansObstetrics & GynecologyGynecologyGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
MEMM0517OtherMEDICARE PTAN
MM0517OtherMEDICARE PTAN