Basic Information
| Provider Information | |||||||||
| NPI: | 1770942005 | ||||||||
| EntityType: | 2 | ||||||||
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| OrganizationName: | CAROLINA WOMEN S RESEARCH AND WELLNESS CENTER | ||||||||
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| Mailing Information | |||||||||
| Address1: | 4020 WESTCHASE BLVD | ||||||||
| Address2: | SUITE 475 | ||||||||
| City: | RALEIGH | ||||||||
| State: | NC | ||||||||
| PostalCode: | 276073938 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 9193340150 | ||||||||
| FaxNumber: | 0103340152 | ||||||||
| Practice Location | |||||||||
| Address1: | 249 E NC HIGHWAY 54 | ||||||||
| Address2: | SUITE 330 | ||||||||
| City: | DURHAM | ||||||||
| State: | NC | ||||||||
| PostalCode: | 277137512 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 9192519223 | ||||||||
| FaxNumber: | 9192519343 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 02/15/2016 | ||||||||
| LastUpdateDate: | 02/15/2016 | ||||||||
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| AuthorizedOfficialLastName: | BALDWIN | ||||||||
| AuthorizedOfficialFirstName: | SHELIA | ||||||||
| AuthorizedOfficialMiddleName: | M | ||||||||
| AuthorizedOfficialTitleorPosition: | DIRECTOR | ||||||||
| AuthorizedOfficialTelephone: | 9193340150 | ||||||||
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| IsOrganizationSubpart: | Y | ||||||||
| ParentOrganizationLBN: | UWH OF NORTH CAROLINA, LLP | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 207VG0400X | Y | 193400000X SINGLE SPECIALTY GROUP | Allopathic & Osteopathic Physicians | Obstetrics & Gynecology | Gynecology |
No ID Information.