Healthcare Provider Details

I. General information

NPI: 1518303742
Provider Name (Legal Business Name): CENTER FOR CONTINENCE AND PELVIC SUPPORT PC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 05/15/2013
Last Update Date: 11/21/2013
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

110 HOSPITAL RD STE 203
PRINCE FREDERICK MD
20678-4019
US

IV. Provider business mailing address

3289 WOODBURN RD STE 130
ANNANDALE VA
22003-6800
US

V. Phone/Fax

Practice location:
  • Phone: 571-389-7140
  • Fax: 703-992-7584
Mailing address:
  • Phone: 571-389-7140
  • Fax: 703-992-7584

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207VF0040X
TaxonomyUrogynecology and Reconstructive Pelvic Surgery (Obstetrics & Gynecology) Physician
License Number
License Number State

VIII. Authorized Official

Name: DR. JEFFREY ALAN WELGOSS
Title or Position: PRESIDENT
Credential: MD
Phone: 571-389-7140