Healthcare Provider Details

I. General information

NPI: 1245314319
Provider Name (Legal Business Name): GYNEKON PLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 10/25/2006
Last Update Date: 12/01/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

6355 WALKER LN SUITE 500
ALEXANDRIA VA
22310-3245
US

IV. Provider business mailing address

PO BOX 751916
LAS VEGAS NV
89136-1916
US

V. Phone/Fax

Practice location:
  • Phone: 703-822-9370
  • Fax:
Mailing address:
  • Phone: 703-822-9370
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code207VG0400X
TaxonomyGynecology Physician
License NumberD0059703
License Number StateMD
# 2
Primary TaxonomyY
Taxonomy Code207VG0400X
TaxonomyGynecology Physician
License Number0101046449
License Number StateVA

VIII. Authorized Official

Name: ROZANNE GENYVE EVINDA BENTT
Title or Position: MEMBER
Credential: MD
Phone: 703-822-9370