=====================================================
General NPI Number Information
=====================================================
NPI Number | 1992769624
-----------------------------------------------------
Entity Type | Organization
-----------------------------------------------------
Legal Business Name | WOMEN'S HEALTH ALLIANCE PKA CENTRE OBSTETRICS AND GYNECOLOGY
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 04/12/2006
-----------------------------------------------------
Last Update Date | 04/27/2017
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 4414 LAKE BOONE TRL SUITE 205
-----------------------------------------------------
City | RALEIGH
-----------------------------------------------------
State | NC
-----------------------------------------------------
Zip | 27607-7514
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 919-788-4444
-----------------------------------------------------
Fax | 919-788-4464
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 4414 LAKE BOONE TRL SUITE 205
-----------------------------------------------------
City | RALEIGH
-----------------------------------------------------
State | NC
-----------------------------------------------------
Zip | 27607-7514
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 919-788-4444
-----------------------------------------------------
Fax | 919-788-4464
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position | PRESIDENT
-----------------------------------------------------
Name | ROBERT LITTLETON
-----------------------------------------------------
Credential | MD
-----------------------------------------------------
Telephone | 919-788-4444
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 207V00000X
-----------------------------------------------------
Taxonomy Name | Obstetrics & Gynecology Physician
-----------------------------------------------------
License Number | 90328
-----------------------------------------------------
License Number State | NC
-----------------------------------------------------