Basic Information
Provider Information
NPI: 1861698268
EntityType: 2
ReplacementNPI:  
OrganizationName: WOMENS HEALTH CARE GROUP OF PENNSYLVANIA LLC
LastName:  
FirstName:  
MiddleName:  
NamePrefix:  
NameSuffix:  
Credential:  
OtherOrganizationName: WHCGPA THE MCCONNELL DIVISION
OtherOrganizationType: 3
OtherLastName:  
OtherFirstName:  
OtherMiddleName:  
OtherNamePrefix:  
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OtherCredential:  
OtherLastNameType:  
Mailing Information
Address1: PO BOX 1109
Address2:  
City: OAKS
State: PA
PostalCode: 194561109
CountryCode: US
TelephoneNumber: 6104824778
FaxNumber: 6106663310
Practice Location
Address1: 100 E LANCASTER AVE
Address2: MEDICAL BUILDING EAST SUITE 158
City: WYNNEWOOD
State: PA
PostalCode: 190963450
CountryCode: US
TelephoneNumber: 6106492129
FaxNumber: 6106427814
Other Information
ProviderEnumerationDate: 06/22/2007
LastUpdateDate: 01/28/2018
NPIDeactivationReasonCode:  
NPIDeactivationDate:  
NPIReactivationDate:  
ProviderGenderCode:  
AuthorizedOfficialLastName: IMBESI
AuthorizedOfficialFirstName: CATHY
AuthorizedOfficialMiddleName:  
AuthorizedOfficialTitleorPosition: DIRECTOR OF CREDENTIALING
AuthorizedOfficialTelephone: 6104824778
IsSoleProprietor:  
IsOrganizationSubpart: N
ParentOrganizationLBN:  
AuthorizedOfficialNamePrefix:  
AuthorizedOfficialNameSuffix:  
AuthorizedOfficialCredential:  
NPICertificationDate:  

Taxonomy Information
TaxonomyLicenseStateSwitchTaxonomyGroupTaxonomyTypeTaxonomyClassSubSpecialty
207V00000X  Y193400000X SINGLE SPECIALTY GROUPAllopathic & Osteopathic PhysiciansObstetrics & Gynecology 

No ID Information.


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