Provider Demographics
NPI:1194031021
Name:OBSTETRICAL AND GYNECOLOGICAL ASSOCIATES P C
Entity type:Organization
Organization Name:OBSTETRICAL AND GYNECOLOGICAL ASSOCIATES P C
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OFFICE MANAGER
Authorized Official - Prefix:MS
Authorized Official - First Name:LYNNE
Authorized Official - Middle Name:M
Authorized Official - Last Name:BOYLAN
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:703-430-8844
Mailing Address - Street 1:21475 RIDGETOP CIR
Mailing Address - Street 2:# 360
Mailing Address - City:STERLING
Mailing Address - State:VA
Mailing Address - Zip Code:20166-6580
Mailing Address - Country:US
Mailing Address - Phone:703-430-8844
Mailing Address - Fax:703-430-3777
Practice Address - Street 1:21475 RIDGETOP CIR
Practice Address - Street 2:# 360
Practice Address - City:STERLING
Practice Address - State:VA
Practice Address - Zip Code:20166-6580
Practice Address - Country:US
Practice Address - Phone:703-430-8844
Practice Address - Fax:703-430-3777
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2010-08-30
Last Update Date:2012-11-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA207VG0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207VG0400XAllopathic & Osteopathic PhysiciansObstetrics & GynecologyGynecologyGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
VAE82005Medicare UPIN