Healthcare Provider Details

I. General information

NPI: 1457348732
Provider Name (Legal Business Name): RICHMOND OB GYN PA
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 10/03/2005
Last Update Date: 08/22/2020
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

921 S LONG DR STE 207
ROCKINGHAM NC
28379-4874
US

IV. Provider business mailing address

PO BOX 304
ROCKINGHAM NC
28380-0304
US

V. Phone/Fax

Practice location:
  • Phone: 910-417-3477
  • Fax: 910-417-3489
Mailing address:
  • Phone: 910-417-3477
  • Fax: 910-417-3489

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207V00000X
TaxonomyObstetrics & Gynecology Physician
License Number29343
License Number StateNC

VIII. Authorized Official

Name: PATRICIA L MIDDLETON
Title or Position: PRESIDENT
Credential: MD FACS
Phone: 910-417-3477