Basic Information
Provider Information
NPI: 1194053009
EntityType: 2
ReplacementNPI:  
OrganizationName: REGIONAL WOMEN'S HEALTH GROUP, LLC
LastName:  
FirstName:  
MiddleName:  
NamePrefix:  
NameSuffix:  
Credential:  
OtherOrganizationName: RWHG CAPE OB GYN ASSO.
OtherOrganizationType: 3
OtherLastName:  
OtherFirstName:  
OtherMiddleName:  
OtherNamePrefix:  
OtherNameSuffix:  
OtherCredential:  
OtherLastNameType:  
Mailing Information
Address1: 227 LAUREL RD
Address2: STE 300
City: VOORHEES
State: NJ
PostalCode: 080438303
CountryCode: US
TelephoneNumber: 8566696050
FaxNumber: 8566510794
Practice Location
Address1: 223 N MAIN ST STE 101
Address2:  
City: CAPE MAY COURT HOUSE
State: NJ
PostalCode: 082102182
CountryCode: US
TelephoneNumber: 6094657557
FaxNumber: 6094659383
Other Information
ProviderEnumerationDate: 12/04/2009
LastUpdateDate: 02/28/2020
NPIDeactivationReasonCode:  
NPIDeactivationDate:  
NPIReactivationDate:  
ProviderGenderCode:  
AuthorizedOfficialLastName: DONOVAN
AuthorizedOfficialFirstName: EDWARD
AuthorizedOfficialMiddleName:  
AuthorizedOfficialTitleorPosition: VP
AuthorizedOfficialTelephone: 8566696050
IsSoleProprietor:  
IsOrganizationSubpart: N
ParentOrganizationLBN:  
AuthorizedOfficialNamePrefix:  
AuthorizedOfficialNameSuffix:  
AuthorizedOfficialCredential:  
NPICertificationDate: 02/28/2020

Taxonomy Information
TaxonomyLicenseStateSwitchTaxonomyGroupTaxonomyTypeTaxonomyClassSubSpecialty
207VX0000X  Y193400000X SINGLE SPECIALTY GROUPAllopathic & Osteopathic PhysiciansObstetrics & GynecologyObstetrics

No ID Information.


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