Basic Information
| Provider Information | |||||||||
| NPI: | 1437191608 | ||||||||
| EntityType: | 2 | ||||||||
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| OrganizationName: | WOMENS HEALTH CARE GROUP OF PENNSYLVANIA LLC | ||||||||
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| Mailing Information | |||||||||
| Address1: | PO BOX 1109 | ||||||||
| Address2: | |||||||||
| City: | OAKS | ||||||||
| State: | PA | ||||||||
| PostalCode: | 194561109 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 4848310200 | ||||||||
| FaxNumber: | 4848310209 | ||||||||
| Practice Location | |||||||||
| Address1: | 450 CRESSON BLVD | ||||||||
| Address2: | SUITE 300 | ||||||||
| City: | OAKS | ||||||||
| State: | PA | ||||||||
| PostalCode: | 19456 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 4848310200 | ||||||||
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| Other Information | |||||||||
| ProviderEnumerationDate: | 06/12/2006 | ||||||||
| LastUpdateDate: | 08/16/2013 | ||||||||
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| AuthorizedOfficialLastName: | KRELL | ||||||||
| AuthorizedOfficialFirstName: | STEPHEN | ||||||||
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| AuthorizedOfficialTitleorPosition: | PRESIDENT | ||||||||
| AuthorizedOfficialTelephone: | 4848310200 | ||||||||
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| IsOrganizationSubpart: | N | ||||||||
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| AuthorizedOfficialNamePrefix: | DR. | ||||||||
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| AuthorizedOfficialCredential: | M.D. | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 207VM0101X | N | 193200000X MULTI-SPECIALTY GROUP | Allopathic & Osteopathic Physicians | Obstetrics & Gynecology | Maternal & Fetal Medicine | 207VE0102X | N | 193200000X MULTI-SPECIALTY GROUP | Allopathic & Osteopathic Physicians | Obstetrics & Gynecology | Reproductive Endocrinology | 207ZC0500X | N | 193200000X MULTI-SPECIALTY GROUP | Allopathic & Osteopathic Physicians | Pathology | Cytopathology | 207ZP0102X | N | 193200000X MULTI-SPECIALTY GROUP | Allopathic & Osteopathic Physicians | Pathology | Anatomic Pathology & Clinical Pathology | 2085R0202X | N | 193200000X MULTI-SPECIALTY GROUP | Allopathic & Osteopathic Physicians | Radiology | Diagnostic Radiology | 207V00000X | Y | 193200000X MULTI-SPECIALTY GROUP | Allopathic & Osteopathic Physicians | Obstetrics & Gynecology |
ID Information
| ID | Type | State | Issuer | Description | 085603 | 01 | PA | MEDICARE GROUP PTAN | OTHER | 1011394540001 | 05 | PA | MEDICAID |