Healthcare Provider Details

I. General information

NPI: 1851339246
Provider Name (Legal Business Name): MID-ATLANTIC WOMENS CARE PLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 06/04/2006
Last Update Date: 03/17/2018
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1080 FIRST COLONIAL RD SUITE 300
VIRGINIA BEACH VA
23454-2406
US

IV. Provider business mailing address

1080 FIRST COLONIAL RD STE 300
VIRGINIA BEACH VA
23454-2406
US

V. Phone/Fax

Practice location:
  • Phone: 757-481-7222
  • Fax: 757-496-3772
Mailing address:
  • Phone: 757-481-7222
  • Fax: 757-496-3772

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: TRACY WRIGHT
Title or Position: PRESIDENT
Credential: MD
Phone: 757-481-7222