Provider Demographics
NPI:1306372511
Name:WOMEN'S HEALTH ALLIANCE, PA PKA CENTRE OBSTETRICS AND GYNECOLOGY
Entity type:Organization
Organization Name:WOMEN'S HEALTH ALLIANCE, PA PKA CENTRE OBSTETRICS AND GYNECOLOGY
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PHYSICIAN
Authorized Official - Prefix:DR
Authorized Official - First Name:ROBERT
Authorized Official - Middle Name:
Authorized Official - Last Name:LITTLETON
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:919-788-4444
Mailing Address - Street 1:4414 LAKE BOONE TRL
Mailing Address - Street 2:SUITE 205
Mailing Address - City:RALEIGH
Mailing Address - State:NC
Mailing Address - Zip Code:27607-7513
Mailing Address - Country:US
Mailing Address - Phone:919-788-4444
Mailing Address - Fax:
Practice Address - Street 1:781 AVENT FERRY RD
Practice Address - Street 2:SUITE 106
Practice Address - City:HOLLY SPRINGS
Practice Address - State:NC
Practice Address - Zip Code:27540-7776
Practice Address - Country:US
Practice Address - Phone:919-788-4444
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:WOMEN'S HEALTH ALLIANCE, PA PKA CENTRE OBSTETRICS AND GYNECOLOGY
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2017-05-08
Last Update Date:2017-05-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC90328207V00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207V00000XAllopathic & Osteopathic PhysiciansObstetrics & GynecologyGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
NC019G8OtherBCBS NC
NC2343239KMedicare UPIN