Healthcare Provider Details

I. General information

NPI: 1891733358
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

1181 FIRST COLONIAL RD SUITE 200
VIRGINIA BEACH VA
23454-2437
US

IV. Provider business mailing address

1181 FIRST COLONIAL RD SUITE 200
VIRGINIA BEACH VA
23454-2437
US

V. Phone/Fax

Practice location:
  • Phone: 757-425-1600
  • Fax: 757-425-6495
Mailing address:
  • Phone: 757-425-1600
  • Fax: 757-425-6495

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. MARY A BURNS
Title or Position: AUTHORIZED OFFICIAL
Credential: MD
Phone: 757-425-1600