Healthcare Provider Details

I. General information

NPI: 1568591964
Provider Name (Legal Business Name): WHOLE WOMAN'S HEALTH OF BALTIMORE LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 03/04/2007
Last Update Date: 01/16/2020
Certification Date: 01/16/2020
Deactivation Date:
Reactivation Date:

III. Provider practice location address

7648 BELAIR RD
BALTIMORE MD
21236-4088
US

IV. Provider business mailing address

1001 E MARKET ST STE 200
CHARLOTTESVILLE VA
22902-5381
US

V. Phone/Fax

Practice location:
  • Phone: 410-661-2900
  • Fax: 410-661-2259
Mailing address:
  • Phone: 512-835-6858
  • Fax: 410-661-2259

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207V00000X
TaxonomyObstetrics & Gynecology Physician
License Number
License Number State

VIII. Authorized Official

Name: AMY HAGSTROM MILLER
Title or Position: CEO
Credential:
Phone: 512-835-6691