Provider Demographics
NPI:1063557098
Name:MID-ATLANTIC WOMENS CARE PLC
Entity type:Organization
Organization Name:MID-ATLANTIC WOMENS CARE PLC
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:DERWIN
Authorized Official - Middle Name:
Authorized Official - Last Name:GRAY
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:757-547-2322
Mailing Address - Street 1:1101 MADISON PLZ
Mailing Address - Street 2:SUITE 201
Mailing Address - City:CHESAPEAKE
Mailing Address - State:VA
Mailing Address - Zip Code:23320-5179
Mailing Address - Country:US
Mailing Address - Phone:757-547-2322
Mailing Address - Fax:757-547-9439
Practice Address - Street 1:1101 MADISON PLZ
Practice Address - Street 2:SUITE 201
Practice Address - City:CHESAPEAKE
Practice Address - State:VA
Practice Address - Zip Code:23320-5179
Practice Address - Country:US
Practice Address - Phone:757-547-2322
Practice Address - Fax:757-547-9439
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:MID-ATLANTIC WOMENS CARE PLC
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2007-02-20
Last Update Date:2018-03-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207V00000XAllopathic & Osteopathic PhysiciansObstetrics & GynecologyGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
VAC05959Medicare PIN