Provider Demographics
NPI:1316975113
Name:OBSTETRICS AND GYNECOLOGY ASSOCIATES OF THE EASTERN SHORE, INC.
Entity type:Organization
Organization Name:OBSTETRICS AND GYNECOLOGY ASSOCIATES OF THE EASTERN SHORE, INC.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT/OWNER
Authorized Official - Prefix:
Authorized Official - First Name:DAVID
Authorized Official - Middle Name:R
Authorized Official - Last Name:SCOTT
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:757-442-6719
Mailing Address - Street 1:PO BOX 836
Mailing Address - Street 2:
Mailing Address - City:NASSAWADOX
Mailing Address - State:VA
Mailing Address - Zip Code:23413-0836
Mailing Address - Country:US
Mailing Address - Phone:757-442-6719
Mailing Address - Fax:757-442-7378
Practice Address - Street 1:10243 ROGERS DRIVE
Practice Address - Street 2:
Practice Address - City:NASSAWADOX
Practice Address - State:VA
Practice Address - Zip Code:23413-0836
Practice Address - Country:US
Practice Address - Phone:757-442-6719
Practice Address - Fax:757-442-7375
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-06-29
Last Update Date:2008-05-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207V00000XAllopathic & Osteopathic PhysiciansObstetrics & GynecologyGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
VACN3911OtherRAILROAD MEDICARE PTAN
VAC02245OtherMEDICARE PTAN