Healthcare Provider Details

I. General information

NPI: 1780353680
Provider Name (Legal Business Name): WOMEN'S EXECUTIVE HEALTHCARE, PC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 09/13/2021
Last Update Date: 09/13/2021
Certification Date: 08/27/2021
Deactivation Date:
Reactivation Date:

III. Provider practice location address

11747 JEFFERSON AVE STE 1B
NEWPORT NEWS VA
23606-4401
US

IV. Provider business mailing address

11747 JEFFERSON AVE STE 1B
NEWPORT NEWS VA
23606-4401
US

V. Phone/Fax

Practice location:
  • Phone: 757-592-9600
  • Fax:
Mailing address:
  • Phone: 757-592-9600
  • Fax:

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: DR. DRINA ANNE NORTHAM
Title or Position: PRESIDENT
Credential: M.D.
Phone: 757-592-9600