Provider Demographics
NPI:1194751867
Name:WEST END OBSTETRICS & GYNECOLOGY, PC
Entity type:Organization
Organization Name:WEST END OBSTETRICS & GYNECOLOGY, PC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRACTICE ADMINISTRATOR
Authorized Official - Prefix:MRS
Authorized Official - First Name:CAROLYN
Authorized Official - Middle Name:D
Authorized Official - Last Name:MCDANIEL
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:804-282-9479
Mailing Address - Street 1:PO BOX 79164
Mailing Address - Street 2:
Mailing Address - City:BALTIMORE
Mailing Address - State:MD
Mailing Address - Zip Code:21279-0164
Mailing Address - Country:US
Mailing Address - Phone:804-282-9479
Mailing Address - Fax:808-285-9805
Practice Address - Street 1:7601 FOREST AVE
Practice Address - Street 2:SUITE 100
Practice Address - City:RICHMOND
Practice Address - State:VA
Practice Address - Zip Code:23229-4933
Practice Address - Country:US
Practice Address - Phone:804-282-9479
Practice Address - Fax:804-285-9805
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-06-24
Last Update Date:2011-12-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes174400000XOther Service ProvidersSpecialistGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
VAC09820Medicare ID - Type UnspecifiedGROUP NUMBER