Basic Information
| Provider Information | |||||||||
| NPI: | 1053471748 | ||||||||
| EntityType: | 2 | ||||||||
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| OrganizationName: | PRINCE WILLIAM OBGYN ASSOCIATES, LTD. | ||||||||
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| Mailing Information | |||||||||
| Address1: | 8640 SUDLEY ROAD | ||||||||
| Address2: | SUITE 303 | ||||||||
| City: | MANASSAS | ||||||||
| State: | VA | ||||||||
| PostalCode: | 201104404 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 7033617778 | ||||||||
| FaxNumber: | 7033926231 | ||||||||
| Practice Location | |||||||||
| Address1: | 8640 SUDLEY ROAD | ||||||||
| Address2: | SUITE 303 | ||||||||
| City: | MANASSAS | ||||||||
| State: | VA | ||||||||
| PostalCode: | 201104404 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 7033617778 | ||||||||
| FaxNumber: | 7033926231 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 12/11/2006 | ||||||||
| LastUpdateDate: | 11/11/2010 | ||||||||
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| AuthorizedOfficialLastName: | GUTLIPH | ||||||||
| AuthorizedOfficialFirstName: | JOANNE | ||||||||
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| AuthorizedOfficialTitleorPosition: | MANAGING PARTNER | ||||||||
| AuthorizedOfficialTelephone: | 7033617778 | ||||||||
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| IsOrganizationSubpart: | N | ||||||||
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| AuthorizedOfficialCredential: | MD | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 207V00000X | Y | 193400000X SINGLE SPECIALTY GROUP | Allopathic & Osteopathic Physicians | Obstetrics & Gynecology |
No ID Information.