Healthcare Provider Details

I. General information

NPI: 1568547883
Provider Name (Legal Business Name): INTEGRATED OB GYN SERVICES
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 10/26/2006
Last Update Date: 04/11/2008
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

7610 PENNSYLVANIA AVE SUITE 305
FORESTVILLE MD
20747-4701
US

IV. Provider business mailing address

7610 PENNSYLVANIA AVE SUITE 305
FORESTVILLE MD
20747-4701
US

V. Phone/Fax

Practice location:
  • Phone: 301-669-1870
  • Fax: 301-669-1873
Mailing address:
  • Phone: 301-669-1870
  • Fax: 301-669-1873

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code174400000X
TaxonomySpecialist
License NumberD22219
License Number StateMD

VIII. Authorized Official

Name: MS. CORALEE POWELL
Title or Position: PRACTICE ADMIN
Credential:
Phone: 301-669-1870