Provider Demographics
NPI:1396783742
Name:WOMEN'S HEALTH AFFILIATES, INC.
Entity type:Organization
Organization Name:WOMEN'S HEALTH AFFILIATES, INC.
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:KEITH
Authorized Official - Middle Name:S
Authorized Official - Last Name:MERLIN
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:508-941-7062
Mailing Address - Street 1:PO BOX 847476
Mailing Address - Street 2:
Mailing Address - City:BOSTON
Mailing Address - State:MA
Mailing Address - Zip Code:02284-7476
Mailing Address - Country:US
Mailing Address - Phone:508-565-0147
Mailing Address - Fax:508-565-0157
Practice Address - Street 1:680 CENTRE ST
Practice Address - Street 2:
Practice Address - City:BROCKTON
Practice Address - State:MA
Practice Address - Zip Code:02302-3308
Practice Address - Country:US
Practice Address - Phone:508-941-7062
Practice Address - Fax:508-941-6337
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-06-04
Last Update Date:2009-08-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MA207V00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207V00000XAllopathic & Osteopathic PhysiciansObstetrics & GynecologyGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
MAM16621OtherBCBS GROUP #
MA9780246Medicaid
MAM21306Medicare ID - Type UnspecifiedGROUP # RANDOLPH
MAM20335Medicare ID - Type UnspecifiedGROUP #