Provider Demographics
NPI:1952586240
Name:ATLANTIC UROGYNECOLOGY PELVIC MEDICINE AND RECONSTRUCTIVE SURGERY PC
Entity Type:Organization
Organization Name:ATLANTIC UROGYNECOLOGY PELVIC MEDICINE AND RECONSTRUCTIVE SURGERY PC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:CHRISTOPHER
Authorized Official - Middle Name:JOSEPH
Authorized Official - Last Name:WALSHE
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:605-254-5384
Mailing Address - Street 1:5838 HARBOUR VIEW BLVD
Mailing Address - Street 2:HARBOUR VIEW MEDICAL ARTS I
Mailing Address - City:SUFFOLK
Mailing Address - State:VA
Mailing Address - Zip Code:23435-2663
Mailing Address - Country:US
Mailing Address - Phone:605-254-5384
Mailing Address - Fax:
Practice Address - Street 1:5838 HARBOUR VIEW BLVD
Practice Address - Street 2:HARBOUR VIEW MEDICAL ARTS I
Practice Address - City:SUFFOLK
Practice Address - State:VA
Practice Address - Zip Code:23435-2663
Practice Address - Country:US
Practice Address - Phone:605-254-5384
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2008-01-04
Last Update Date:2011-07-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA0101242698207VG0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207VG0400XAllopathic & Osteopathic PhysiciansObstetrics & GynecologyGynecologyGroup - Single Specialty