Provider Demographics
NPI:1699054858
Name:GENERATIONS OF WOMEN OBGYN PC
Entity type:Organization
Organization Name:GENERATIONS OF WOMEN OBGYN PC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:BARBARA
Authorized Official - Middle Name:
Authorized Official - Last Name:MERCADO-STALLARD
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:540-654-8400
Mailing Address - Street 1:1300 HOSPITAL DR
Mailing Address - Street 2:SUITE 302
Mailing Address - City:FREDERICKSBURG
Mailing Address - State:VA
Mailing Address - Zip Code:22401-8451
Mailing Address - Country:US
Mailing Address - Phone:540-654-8400
Mailing Address - Fax:540-322-3086
Practice Address - Street 1:1300 HOSPITAL DR
Practice Address - Street 2:SUITE 302
Practice Address - City:FREDERICKSBURG
Practice Address - State:VA
Practice Address - Zip Code:22401-8451
Practice Address - Country:US
Practice Address - Phone:540-654-8400
Practice Address - Fax:540-322-3086
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2011-08-05
Last Update Date:2014-02-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA0101059310207V00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207V00000XAllopathic & Osteopathic PhysiciansObstetrics & GynecologyGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
VA1396734497Medicaid
VAA477Medicare PIN