Healthcare Provider Details

I. General information

NPI: 1114965043
Provider Name (Legal Business Name): MID-ATLANTIC WOMENS CARE PLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 06/03/2006
Last Update Date: 03/17/2018
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

828 HEALTHY WAY STE 330
VIRGINIA BEACH VA
23462-7959
US

IV. Provider business mailing address

844 KEMPSVILLE RD SUITE 208
NORFOLK VA
23502-3927
US

V. Phone/Fax

Practice location:
  • Phone: 757-461-3890
  • Fax: 757-467-0301
Mailing address:
  • Phone: 757-461-3890
  • Fax: 757-461-0836

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. CHARLES WILKES
Title or Position: PRESIDENT
Credential: MD
Phone: 757-461-3890