Healthcare Provider Details

I. General information

NPI: 1093324162
Provider Name (Legal Business Name): EVOSCIENT GYNECOLOGY CENTER FOR PELVIC HEALTH AND SURGERY, PC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 07/24/2020
Last Update Date: 12/11/2020
Certification Date: 12/11/2020
Deactivation Date:
Reactivation Date:

III. Provider practice location address

700 INDEPENDENCE CIR STE 2A
VIRGINIA BEACH VA
23455-6405
US

IV. Provider business mailing address

700 INDEPENDENCE CIR STE 2A
VIRGINIA BEACH VA
23455-6405
US

V. Phone/Fax

Practice location:
  • Phone: 757-473-2021
  • Fax: 757-518-1110
Mailing address:
  • Phone: 757-473-2021
  • Fax: 757-518-1110

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code207V00000X
TaxonomyObstetrics & Gynecology Physician
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code207VF0040X
TaxonomyUrogynecology and Reconstructive Pelvic Surgery (Obstetrics & Gynecology) Physician
License Number
License Number State
# 3
Primary TaxonomyN
Taxonomy Code225100000X
TaxonomyPhysical Therapist
License Number
License Number State
# 4
Primary TaxonomyY
Taxonomy Code207VG0400X
TaxonomyGynecology Physician
License Number
License Number State

VIII. Authorized Official

Name: DR. MARY NDIDI-EGBUNIWE OJO-CARONS
Title or Position: OWNER
Credential: MD
Phone: 757-473-2021