Provider Demographics
NPI:1184891228
Name:WCH OB GYN PRACTICE, INC
Entity type:Organization
Organization Name:WCH OB GYN PRACTICE, INC
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT/OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:DAVID
Authorized Official - Middle Name:A
Authorized Official - Last Name:ROSADO
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:740-333-5501
Mailing Address - Street 1:207 GLENN AVE
Mailing Address - Street 2:
Mailing Address - City:WASHINGTON COURT HOUSE
Mailing Address - State:OH
Mailing Address - Zip Code:43160-1711
Mailing Address - Country:US
Mailing Address - Phone:740-333-5501
Mailing Address - Fax:740-333-5503
Practice Address - Street 1:207 GLENN AVE
Practice Address - Street 2:
Practice Address - City:WASHINGTON COURT HOUSE
Practice Address - State:OH
Practice Address - Zip Code:43160-1711
Practice Address - Country:US
Practice Address - Phone:740-333-5501
Practice Address - Fax:740-333-5503
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2008-05-08
Last Update Date:2008-05-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH3563403207V00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207V00000XAllopathic & Osteopathic PhysiciansObstetrics & GynecologyGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
OH0882675Medicaid
OHSP00361OtherMEDICARE GROUP NUMBER