Healthcare Provider Details

I. General information

NPI: 1245412048
Provider Name (Legal Business Name): MOUNTAIN VIEW MIDWIFERY
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 12/04/2007
Last Update Date: 12/04/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1208 BLAND CIR
CHARLOTTESVILLE VA
22901-4115
US

IV. Provider business mailing address

1208 BLAND CIRCLE
CHARLOTTESVILLE VA
22901
US

V. Phone/Fax

Practice location:
  • Phone: 434-962-0148
  • Fax: 703-564-8562
Mailing address:
  • Phone: 434-962-0148
  • Fax: 703-564-8562

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code176B00000X
TaxonomyMidwife
License Number
License Number StateVA
# 2
Primary TaxonomyY
Taxonomy Code176B00000X
TaxonomyMidwife
License Number
License Number StateVA

VIII. Authorized Official

Name: DR. DEREN ELAINE BADER
Title or Position: PARTNER
Credential: CPM, DRPH
Phone: 434-962-0148