Healthcare Provider Details

I. General information

NPI: 1740946458
Provider Name (Legal Business Name): ADVANCED WOMEN'S CARE CENTER LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 11/17/2021
Last Update Date: 11/17/2021
Certification Date: 11/17/2021
Deactivation Date:
Reactivation Date:

III. Provider practice location address

120 SISTER PIERRE DR STE 408
TOWSON MD
21204-7536
US

IV. Provider business mailing address

120 SISTER PIERRE DR STE 408
TOWSON MD
21204-7536
US

V. Phone/Fax

Practice location:
  • Phone: 410-337-2622
  • Fax: 410-321-5493
Mailing address:
  • Phone: 410-337-2622
  • Fax: 410-321-5493

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207VG0400X
TaxonomyGynecology Physician
License Number
License Number State

VII. Legacy identifiers

For crosswalk purposes, the following legacy (non-NPI) identifiers are available for this provider:

VIII. Authorized Official

Name: DR. STEVEN W. TUCKER
Title or Position: MEDICAL DIRECTOR
Credential: MD
Phone: 410-337-2622