MEDICARE: WOMEN2WOMEN OBSTETRICS AND GYNECOLOGY, LLC

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	207V00000X	Obstetrics & Gynecology Physician

General Provider Information

NPI Number	:	1518504281
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	WOMEN2WOMEN OBSTETRICS AND GYNECOLOGY, LLC

Provider Business Mailing Address
First Line	:	180 HARRY L DR
Second Line	:
City	:	JOHNSON CITY
State	:	NY
Zip	:	13790-1566
Country	:	US
Telephone Number	:
Fax Number	:

Provider Business Practice Location Address
First Line	:	180 HARRY L DR
Second Line	:
City	:	JOHNSON CITY
State	:	NY
Zip	:	13790-1566
Country	:	US
Telephone Number	:	607-417-0500
Fax Number	:

Authorized Official
Title or Position	:	OWNER
Name	:	MELINDA B RUPP
Credential	:	MD
Telephone Number	:	607-417-0500

Provider Enumeration Date	:	12/02/2019
Last Update Date	:	12/02/2019

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