Basic Information
| Provider Information | |||||||||
| NPI: | 1407863699 | ||||||||
| EntityType: | 2 | ||||||||
| ReplacementNPI: | |||||||||
| OrganizationName: | WOMEN'S HEALTH CARE GROUP OF PA, MAIN LINE WOMEN'S HEALTH CARE DIV. | ||||||||
| LastName: | |||||||||
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| OtherOrganizationName: | MAIN LINE WOMEN'S HEALTH CARE ASSOC. | ||||||||
| OtherOrganizationType: | 3 | ||||||||
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| Mailing Information | |||||||||
| Address1: | 1030 E LANCASTER AVE | ||||||||
| Address2: | |||||||||
| City: | BRYN MAWR | ||||||||
| State: | PA | ||||||||
| PostalCode: | 190101451 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 6105253098 | ||||||||
| FaxNumber: | 6105254932 | ||||||||
| Practice Location | |||||||||
| Address1: | 1030 E LANCASTER AVE | ||||||||
| Address2: | |||||||||
| City: | BRYN MAWR | ||||||||
| State: | PA | ||||||||
| PostalCode: | 190101451 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 6105253098 | ||||||||
| FaxNumber: | 6105254932 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 08/01/2006 | ||||||||
| LastUpdateDate: | 07/21/2022 | ||||||||
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| AuthorizedOfficialLastName: | JONES | ||||||||
| AuthorizedOfficialFirstName: | JANINE | ||||||||
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| AuthorizedOfficialTitleorPosition: | BOOKKEEPING COORDINATOR | ||||||||
| AuthorizedOfficialTelephone: | 6105253098 | ||||||||
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| IsOrganizationSubpart: | N | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 207V00000X | Y | 193200000X MULTI-SPECIALTY GROUP | Allopathic & Osteopathic Physicians | Obstetrics & Gynecology |
ID Information
| ID | Type | State | Issuer | Description | 2330379000 | 01 | PA | IBC/PERSONAL CHOICE&KEYS. | OTHER |