MEDICARE: MID-ATLANTIC WOMENS CARE PLC

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	207V00000X	Obstetrics & Gynecology Physician

General Provider Information

NPI Number	:	1114965043
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	MID-ATLANTIC WOMENS CARE PLC

Provider Business Mailing Address
First Line	:	844 KEMPSVILLE RD
Second Line	:	SUITE 208
City	:	NORFOLK
State	:	VA
Zip	:	23502-3927
Country	:	US
Telephone Number	:	757-461-3890
Fax Number	:	757-461-0836

Provider Business Practice Location Address
First Line	:	828 HEALTHY WAY STE 330
Second Line	:
City	:	VIRGINIA BEACH
State	:	VA
Zip	:	23462-7959
Country	:	US
Telephone Number	:	757-461-3890
Fax Number	:	757-467-0301

Authorized Official
Title or Position	:	PRESIDENT
Name	:	DR. CHARLES WILKES
Credential	:	MD
Telephone Number	:	757-461-3890

Provider Enumeration Date	:	06/03/2006
Last Update Date	:	03/17/2018

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