Basic Information
| Provider Information | |||||||||
| NPI: | 1083038384 | ||||||||
| EntityType: | 2 | ||||||||
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| OrganizationName: | TOTAL WOMAN HEALTH AND WELLNESS OBGYN | ||||||||
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| Mailing Information | |||||||||
| Address1: | 450 CRESSON BLVD SUITE 300 | ||||||||
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| City: | OAKS | ||||||||
| State: | PA | ||||||||
| PostalCode: | 194561109 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 4848310200 | ||||||||
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| Practice Location | |||||||||
| Address1: | 609 W GERMANTOWN PIKE | ||||||||
| Address2: | SUITE 270 | ||||||||
| City: | EAST NORRITON | ||||||||
| State: | PA | ||||||||
| PostalCode: | 194034243 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 6102333350 | ||||||||
| FaxNumber: | 6104320545 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 02/07/2014 | ||||||||
| LastUpdateDate: | 02/07/2014 | ||||||||
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| AuthorizedOfficialLastName: | BICKEL | ||||||||
| AuthorizedOfficialFirstName: | NANCY | ||||||||
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| AuthorizedOfficialTitleorPosition: | COO | ||||||||
| AuthorizedOfficialTelephone: | 4848310200 | ||||||||
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| IsOrganizationSubpart: | Y | ||||||||
| ParentOrganizationLBN: | WOMENS HEALTH CARE GROUP OF PENNSYLVANIA LLC | ||||||||
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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 |
ID Information
| ID | Type | State | Issuer | Description | 1011395450 | 05 | PA | MEDICAID |