=====================================================
General NPI Number Information
=====================================================
NPI Number | 1225193972
-----------------------------------------------------
Entity Type | Organization
-----------------------------------------------------
Legal Business Name | EDWARD T. WOLANSKI MD PC
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 12/22/2006
-----------------------------------------------------
Last Update Date | 07/12/2022
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 600 PETER JEFFERSON PKWY STE 300
-----------------------------------------------------
City | CHARLOTTESVILLE
-----------------------------------------------------
State | VA
-----------------------------------------------------
Zip | 22911-8837
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 434-293-9800
-----------------------------------------------------
Fax | 434-977-0088
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 600 PETER JEFFERSON PKWY STE 300
-----------------------------------------------------
City | CHARLOTTESVILLE
-----------------------------------------------------
State | VA
-----------------------------------------------------
Zip | 22911-8837
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 434-293-9800
-----------------------------------------------------
Fax | 434-977-0088
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position | PRESIDENT
-----------------------------------------------------
Name | EDWARD T WOLANSKI
-----------------------------------------------------
Credential | MD
-----------------------------------------------------
Telephone | 434-293-9800
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 207V00000X
-----------------------------------------------------
Taxonomy Name | Obstetrics & Gynecology Physician
-----------------------------------------------------
License Number | 0101039930
-----------------------------------------------------
License Number State | VA
-----------------------------------------------------