Healthcare Provider Details

I. General information

NPI: 1710942503
Provider Name (Legal Business Name): NORTHWESTERN OBSTETRICS & GYNECOLOGY, P.A.
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 04/18/2006
Last Update Date: 07/21/2022
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

166 DOCTORS DR
BOONE NC
28607-5000
US

IV. Provider business mailing address

166 DOCTORS DR
BOONE NC
28607-5000
US

V. Phone/Fax

Practice location:
  • Phone: 828-264-9067
  • Fax: 828-264-9068
Mailing address:
  • Phone: 828-264-9067
  • Fax: 828-264-9068

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code173000000X
TaxonomyLegal Medicine
License Number39517
License Number StateNC

VIII. Authorized Official

Name: DR. JOHN R MARCHESE
Title or Position: PRESIDENT
Credential: MD
Phone: 828-264-9067