Basic Information
| Provider Information | |||||||||
| NPI: | 1407393770 | ||||||||
| EntityType: | 2 | ||||||||
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| OrganizationName: | REGIONAL WOMEN'S HEALTH GROUP, LLC | ||||||||
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| OtherOrganizationName: | RWHG REVITALIFE | ||||||||
| OtherOrganizationType: | 3 | ||||||||
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| Mailing Information | |||||||||
| Address1: | 227 LAUREL RD | ||||||||
| Address2: | 300 | ||||||||
| City: | VOORHEES | ||||||||
| State: | NJ | ||||||||
| PostalCode: | 080438303 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 8566696050 | ||||||||
| FaxNumber: | 8566510794 | ||||||||
| Practice Location | |||||||||
| Address1: | 2301 E EVESHAM RD | ||||||||
| Address2: | 305 | ||||||||
| City: | VOORHEES | ||||||||
| State: | NJ | ||||||||
| PostalCode: | 080434501 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 8568090909 | ||||||||
| FaxNumber: | 8568091919 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 01/25/2017 | ||||||||
| LastUpdateDate: | 02/01/2017 | ||||||||
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| AuthorizedOfficialLastName: | CASO | ||||||||
| AuthorizedOfficialFirstName: | FRANK | ||||||||
| AuthorizedOfficialMiddleName: | J | ||||||||
| AuthorizedOfficialTitleorPosition: | CEO | ||||||||
| AuthorizedOfficialTelephone: | 8566696050 | ||||||||
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| IsOrganizationSubpart: | N | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 207V00000X | Y | 193400000X SINGLE SPECIALTY GROUP | Allopathic & Osteopathic Physicians | Obstetrics & Gynecology |
No ID Information.