Basic Information
| Provider Information | |||||||||
| NPI: | 1316901283 | ||||||||
| EntityType: | 2 | ||||||||
| ReplacementNPI: | |||||||||
| OrganizationName: | WOMENS HEALTHCARE GROUP OF PA. | ||||||||
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| OtherOrganizationName: | GRANITE RUN OB/GYN ASSOCIATES DIVISION | ||||||||
| OtherOrganizationType: | 3 | ||||||||
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| Mailing Information | |||||||||
| Address1: | 1088 W BALTIMORE PIKE | ||||||||
| Address2: | SUITE 2303 | ||||||||
| City: | MEDIA | ||||||||
| State: | PA | ||||||||
| PostalCode: | 190635146 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 6106274400 | ||||||||
| FaxNumber: | 6106274408 | ||||||||
| Practice Location | |||||||||
| Address1: | 1088 W BALTIMORE PIKE | ||||||||
| Address2: | SUITE 2303 | ||||||||
| City: | MEDIA | ||||||||
| State: | PA | ||||||||
| PostalCode: | 190635146 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 6106274400 | ||||||||
| FaxNumber: | 6106274408 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 04/17/2006 | ||||||||
| LastUpdateDate: | 08/22/2020 | ||||||||
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| AuthorizedOfficialLastName: | MONTELLA | ||||||||
| AuthorizedOfficialFirstName: | PAT | ||||||||
| AuthorizedOfficialMiddleName: | A. | ||||||||
| AuthorizedOfficialTitleorPosition: | OFFICE MANAGER | ||||||||
| AuthorizedOfficialTelephone: | 6106274414 | ||||||||
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| IsOrganizationSubpart: | N | ||||||||
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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.