Basic Information
| Provider Information | |||||||||
| NPI: | 1053860999 | ||||||||
| EntityType: | 2 | ||||||||
| ReplacementNPI: | |||||||||
| OrganizationName: | WOMEN'S HEALTHCARE GROUP OF PENNSYLVANIA LLC | ||||||||
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| OtherOrganizationName: | WHCGPA MAIN LINE OB/GYN | ||||||||
| OtherOrganizationType: | 3 | ||||||||
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| Mailing Information | |||||||||
| Address1: | PO BOX 1109 | ||||||||
| Address2: | |||||||||
| City: | OAKS | ||||||||
| State: | PA | ||||||||
| PostalCode: | 194561109 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 6104824778 | ||||||||
| FaxNumber: | 6106663310 | ||||||||
| Practice Location | |||||||||
| Address1: | 85 OLD EAGLE SCHOOL RD | ||||||||
| Address2: | 101 | ||||||||
| City: | STRAFFORD | ||||||||
| State: | PA | ||||||||
| PostalCode: | 190872556 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 6106883744 | ||||||||
| FaxNumber: | 6106884490 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 10/03/2016 | ||||||||
| LastUpdateDate: | 01/28/2018 | ||||||||
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| AuthorizedOfficialLastName: | IMBESI | ||||||||
| AuthorizedOfficialFirstName: | CATHY | ||||||||
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| AuthorizedOfficialTitleorPosition: | DIRECTOR OF CREDENTIALING | ||||||||
| AuthorizedOfficialTelephone: | 6104824778 | ||||||||
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| IsOrganizationSubpart: | N | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 363LX0001X | SP016409 | PA | Y | 193400000X MULTIPLE SINGLE SPECIALTY GROUP | Physician Assistants & Advanced Practice Nursing Providers | Nurse Practitioner | Obstetrics & Gynecology |
No ID Information.