Healthcare Provider Details

I. General information

NPI: 1407878119
Provider Name (Legal Business Name): COMPREHENSIVE WOMENS HEALTH SVC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 07/24/2006
Last Update Date: 11/22/2011
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

622 WASHINGTON STREET
WATERTOWN NY
13601-4036
US

IV. Provider business mailing address

PO BOX 91
WATERTOWN NY
13601
US

V. Phone/Fax

Practice location:
  • Phone: 315-788-2003
  • Fax: 315-788-7087
Mailing address:
  • Phone: 315-782-4207
  • Fax: 315-782-8699

VI. Provider taxonomy

Scope of Practice (Provider specialty)

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

VIII. Authorized Official

Name: WALTER DODARD
Title or Position: ADMINISTRATOR
Credential:
Phone: 315-788-2003