Basic Information
| Provider Information | |||||||||
| NPI: | 1265494355 | ||||||||
| EntityType: | 2 | ||||||||
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| OrganizationName: | WESTSIDE OB/GYN CENTER PA | ||||||||
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| Mailing Information | |||||||||
| Address1: | 1091 KIRKPATRICK RD | ||||||||
| Address2: | |||||||||
| City: | BURLINGTON | ||||||||
| State: | NC | ||||||||
| PostalCode: | 272159714 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 3365381880 | ||||||||
| FaxNumber: | 3365381895 | ||||||||
| Practice Location | |||||||||
| Address1: | 1091 KIRKPATRICK RD | ||||||||
| Address2: | |||||||||
| City: | BURLINGTON | ||||||||
| State: | NC | ||||||||
| PostalCode: | 272159714 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 3365381880 | ||||||||
| FaxNumber: | 3365381895 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 04/04/2006 | ||||||||
| LastUpdateDate: | 07/26/2007 | ||||||||
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| AuthorizedOfficialLastName: | MOSLEY | ||||||||
| AuthorizedOfficialFirstName: | DONNA | ||||||||
| AuthorizedOfficialMiddleName: | M | ||||||||
| AuthorizedOfficialTitleorPosition: | ADMINISTRATOR | ||||||||
| AuthorizedOfficialTelephone: | 3364942060 | ||||||||
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| IsOrganizationSubpart: | N | ||||||||
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| AuthorizedOfficialNamePrefix: | MRS. | ||||||||
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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.