=====================================================
General NPI Number Information
=====================================================
NPI Number | 1699202523
-----------------------------------------------------
Entity Type | Organization
-----------------------------------------------------
Legal Business Name | ADVANCED WOMEN'S HEALTH, LLC
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 05/23/2017
-----------------------------------------------------
Last Update Date | 09/10/2024
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 677 E PULASKI HWY STE C
-----------------------------------------------------
City | ELKTON
-----------------------------------------------------
State | MD
-----------------------------------------------------
Zip | 21921-6037
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 410-620-2000
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 7 POWELL PL
-----------------------------------------------------
City | ELKTON
-----------------------------------------------------
State | MD
-----------------------------------------------------
Zip | 21921-5175
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 443-907-3312
-----------------------------------------------------
Fax | 410-638-2680
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position | MANAGING MEMBER
-----------------------------------------------------
Name | DR. MARYAM AWAN
-----------------------------------------------------
Credential | MD
-----------------------------------------------------
Telephone | 443-907-3312
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 207V00000X
-----------------------------------------------------
Taxonomy Name | Obstetrics & Gynecology Physician
-----------------------------------------------------
License Number |
-----------------------------------------------------
License Number State |
-----------------------------------------------------