Provider Demographics
NPI:1457538290
Name:OLDE TOWNE OBSTETRICS & GYNECOLOGY, LLC
Entity Type:Organization
Organization Name:OLDE TOWNE OBSTETRICS & GYNECOLOGY, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CEO
Authorized Official - Prefix:DR
Authorized Official - First Name:CHERYL
Authorized Official - Middle Name:A
Authorized Official - Last Name:FERRIER
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:703-739-8888
Mailing Address - Street 1:3131 MT. VERNON AVE.
Mailing Address - Street 2:
Mailing Address - City:ALEXANDRIA
Mailing Address - State:VA
Mailing Address - Zip Code:22305
Mailing Address - Country:US
Mailing Address - Phone:703-739-8888
Mailing Address - Fax:703-519-8728
Practice Address - Street 1:3131 MOUNT VERNON AVE
Practice Address - Street 2:
Practice Address - City:ALEXANDRIA
Practice Address - State:VA
Practice Address - Zip Code:22305-2640
Practice Address - Country:US
Practice Address - Phone:703-739-8888
Practice Address - Fax:703-519-8728
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2008-01-23
Last Update Date:2009-07-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207V00000XAllopathic & Osteopathic PhysiciansObstetrics & GynecologyGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
VAG00932Medicare PIN