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General NPI Number Information
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NPI Number | 1598872269
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Entity Type | Organization
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Legal Business Name | BROOKVIEW WOMENS CENTER PLLC
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Dates
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Enumeration Date | 08/25/2006
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Last Update Date | 10/20/2010
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Provider Practice Location Address
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Address Line | 3333 BROOKVIEW HILLS BLVD SUITE 105
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City | WINSTON SALEM
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State | NC
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Zip | 27103-5661
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Country | US
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Telephone | 336-765-1464
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Fax | 336-760-2492
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Provider Business Mailing Address
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Address Line | 3333 BROOKVIEW HILLS BLVD SUITE 105
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City | WINSTON SALEM
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State | NC
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Zip | 27103-5661
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Country | US
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Telephone | 336-765-1464
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Fax | 336-760-2492
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Authorized Official
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Title or Position | OWNER
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Name | DR. DONALD EDWARD PITTAWAY SR.
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Credential | M.D.
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Telephone | 336-765-1464
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 261QM2500X
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Taxonomy Name | Medical Specialty Clinic/Center
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License Number |
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License Number State | NC
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