Provider Demographics
NPI:1932339355
Name:WOMEN'S HEALTH CARE GROUP OF PA
Entity Type:Organization
Organization Name:WOMEN'S HEALTH CARE GROUP OF PA
Other - Org Name:OBGYN HEALTHCARE ASSOCIATES AT RIDDLE
Other - Org Type:Doing Business As
Authorized Official - Title/Position:PHYSICIAN
Authorized Official - Prefix:DR
Authorized Official - First Name:LANE
Authorized Official - Middle Name:K
Authorized Official - Last Name:SHIMA
Authorized Official - Suffix:
Authorized Official - Credentials:DO
Authorized Official - Phone:484-443-2880
Mailing Address - Street 1:1088 W BALTIMORE PIKE
Mailing Address - Street 2:SUITE 3415
Mailing Address - City:MEDIA
Mailing Address - State:PA
Mailing Address - Zip Code:19063-5146
Mailing Address - Country:US
Mailing Address - Phone:484-443-2880
Mailing Address - Fax:484-443-2885
Practice Address - Street 1:1088 W BALTIMORE PIKE
Practice Address - Street 2:SUITE 3415
Practice Address - City:MEDIA
Practice Address - State:PA
Practice Address - Zip Code:19063-5146
Practice Address - Country:US
Practice Address - Phone:484-443-2880
Practice Address - Fax:484-443-2885
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2009-07-20
Last Update Date:2009-07-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207V00000XAllopathic & Osteopathic PhysiciansObstetrics & GynecologyGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
PA0115769000OtherIBC PROVIDER NUMBER