Healthcare Provider Details

I. General information

NPI: 1578770160
Provider Name (Legal Business Name): WOMEN'S HEALTH SPECIALISTS OF MONTGOMERY COUNTY, LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 05/16/2007
Last Update Date: 05/21/2025
Certification Date: 05/21/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

6301 EXECUTIVE BLVD
ROCKVILLE MD
20852-3905
US

IV. Provider business mailing address

6301 EXECUTIVE BLVD
ROCKVILLE MD
20852-3905
US

V. Phone/Fax

Practice location:
  • Phone: 301-770-4967
  • Fax: 844-251-4625
Mailing address:
  • Phone: 301-770-4967
  • Fax: 301-770-3205

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code207VX0201X
TaxonomyGynecologic Oncology Physician
License Number
License Number StateMD
# 2
Primary TaxonomyN
Taxonomy Code208600000X
TaxonomySurgery Physician
License Number
License Number StateMD
# 3
Primary TaxonomyN
Taxonomy Code363A00000X
TaxonomyPhysician Assistant
License NumberC0001760
License Number StateMD
# 4
Primary TaxonomyN
Taxonomy Code367A00000X
TaxonomyAdvanced Practice Midwife
License NumberR126791
License Number StateMD
# 5
Primary TaxonomyY
Taxonomy Code207VG0400X
TaxonomyGynecology Physician
License Number
License Number StateMD

VIII. Authorized Official

Name: VICTORIA DODSON
Title or Position: CREDENTIALING MANAGER
Credential:
Phone: 443-398-0189