Provider Demographics
NPI:1750329843
Name:MID-ATLANTIC WOMENS CARE PLC
Entity type:Organization
Organization Name:MID-ATLANTIC WOMENS CARE PLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:HOLLY
Authorized Official - Middle Name:S
Authorized Official - Last Name:PURITZ
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:757-466-6388
Mailing Address - Street 1:880 KEMPSVILLE RD
Mailing Address - Street 2:SUITE 2200
Mailing Address - City:NORFOLK
Mailing Address - State:VA
Mailing Address - Zip Code:23502-3931
Mailing Address - Country:US
Mailing Address - Phone:757-466-6350
Mailing Address - Fax:757-466-9262
Practice Address - Street 1:880 KEMPSVILLE RD
Practice Address - Street 2:SUITE 2200
Practice Address - City:NORFOLK
Practice Address - State:VA
Practice Address - Zip Code:23502-3931
Practice Address - Country:US
Practice Address - Phone:757-466-6350
Practice Address - Fax:757-466-9262
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:MID-ATLANTIC WOMENS CARE PLC
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2006-06-02
Last Update Date:2018-03-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207V00000XAllopathic & Osteopathic PhysiciansObstetrics & GynecologyGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
VAC05059Medicare PIN
M7275Medicare PIN