Healthcare Provider Details

I. General information

NPI: 1396035051
Provider Name (Legal Business Name): CHURCHLAND OBSTETRICS AND
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 04/15/2011
Last Update Date: 10/03/2012
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

4041 TAYLOR RD SUITE C
CHESAPEAKE VA
23321-5536
US

IV. Provider business mailing address

4041 TAYLOR RD SUITE C
CHESAPEAKE VA
23321-5536
US

V. Phone/Fax

Practice location:
  • Phone: 757-483-4600
  • Fax:
Mailing address:
  • Phone: 757-483-4600
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207VG0400X
TaxonomyGynecology Physician
License Number0101041711
License Number StateVA

VIII. Authorized Official

Name: DR. CYNTHIA H MOBLEY
Title or Position: PRESIDENT
Credential: MD
Phone: 757-483-4600