MEDICARE: WOMENS HEALTH ASSOCIATION OF TITUSVILLE

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	029120E	PA
2	207V00000X	Obstetrics & Gynecology Physician	044541L	PA

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	000276090	OTHER	PA	HIGHMARK
2	W0276090	OTHER	PA	BCBS

General Provider Information

NPI Number	:	1306957030
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	WOMENS HEALTH ASSOCIATION OF TITUSVILLE

Provider Business Mailing Address
First Line	:	602 W CENTRAL AVE
Second Line	:
City	:	TITUSVILLE
State	:	PA
Zip	:	16354-2152
Country	:	US
Telephone Number	:	814-827-7229
Fax Number	:	814-827-4869

Provider Business Practice Location Address
First Line	:	602 W CENTRAL AVE
Second Line	:
City	:	TITUSVILLE
State	:	PA
Zip	:	16354-2152
Country	:	US
Telephone Number	:	814-827-7229
Fax Number	:	814-827-4869

Authorized Official
Title or Position	:	MD
Name	:	RUTHELLEN DENISE WEEKS
Credential	:	MD
Telephone Number	:	814-827-7229

Provider Enumeration Date	:	08/31/2006
Last Update Date	:	08/17/2011

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Directions to “WOMENS HEALTH ASSOCIATION OF TITUSVILLE ” Practice Location

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