Healthcare Provider Details

I. General information

NPI: 1073697538
Provider Name (Legal Business Name): A WOMAN'S PLACE OBGYN ASSOCIATES PC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 10/24/2006
Last Update Date: 09/03/2009
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

668 N CHURCH ST SUITE 20
HAZLETON PA
18201-3194
US

IV. Provider business mailing address

668 N CHURCH ST SUITE 20
HAZLETON PA
18201-3194
US

V. Phone/Fax

Practice location:
  • Phone: 570-450-6454
  • Fax: 570-450-2048
Mailing address:
  • Phone: 570-450-6454
  • Fax: 570-450-2048

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207V00000X
TaxonomyObstetrics & Gynecology Physician
License NumberOS009234L
License Number StatePA

VII. Legacy identifiers

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

VIII. Authorized Official

Name: JILL T. SNYDER
Title or Position: OWNER
Credential: D.O.
Phone: 570-450-6454