Provider Demographics
NPI:1396775037
Name:WOMEN TO WOMEN MEDICAL GROUP, INC.
Entity type:Organization
Organization Name:WOMEN TO WOMEN MEDICAL GROUP, INC.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:M.D.
Authorized Official - Prefix:
Authorized Official - First Name:SUSAN
Authorized Official - Middle Name:
Authorized Official - Last Name:PODOLSKY
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:209-869-5678
Mailing Address - Street 1:2603 PATTERSON RD
Mailing Address - Street 2:SUITE 1
Mailing Address - City:RIVERBANK
Mailing Address - State:CA
Mailing Address - Zip Code:95367-3407
Mailing Address - Country:US
Mailing Address - Phone:209-869-5678
Mailing Address - Fax:209-869-6357
Practice Address - Street 1:2603 PATTERSON RD
Practice Address - Street 2:SUITE 1
Practice Address - City:RIVERBANK
Practice Address - State:CA
Practice Address - Zip Code:95367-3407
Practice Address - Country:US
Practice Address - Phone:209-869-5678
Practice Address - Fax:209-869-6357
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-07-04
Last Update Date:2015-10-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAG62868207V00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207V00000XAllopathic & Osteopathic PhysiciansObstetrics & GynecologyGroup - Single Specialty