MEDICARE: WOMENS CARE CENTER OF ERIE COUNTY INC

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	MD042517E	PA
2	261Q00000X	Clinic/Center
3	363LW0102X	Women's Health Nurse Practitioner	SP002262G	PA

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number	:	1164415766
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	WOMENS CARE CENTER OF ERIE COUNTY INC

Provider Business Mailing Address
First Line	:	4402 PEACH ST
Second Line	:	STE 302
City	:	ERIE
State	:	PA
Zip	:	16509-1358
Country	:	US
Telephone Number	:	814-866-2010
Fax Number	:	814-868-3420

Provider Business Practice Location Address
First Line	:	4402 PEACH ST
Second Line	:	STE 302
City	:	ERIE
State	:	PA
Zip	:	16509-1358
Country	:	US
Telephone Number	:	814-866-2010
Fax Number	:	814-868-3420

Authorized Official
Title or Position	:	EXECUTIVE DIRECTOR
Name	:	BRENDA E NEWPORT
Credential	:
Telephone Number	:	814-836-7505

Provider Enumeration Date	:	08/30/2005
Last Update Date	:	09/11/2025

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