Provider Demographics
NPI:1033140280
Name:WILLIAMSPORT OBSTETRICS & GYNECOLOGY, P.C.
Entity type:Organization
Organization Name:WILLIAMSPORT OBSTETRICS & GYNECOLOGY, P.C.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PHYSICIAN/PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:ROBERT
Authorized Official - Middle Name:ANTHONY
Authorized Official - Last Name:DONATO
Authorized Official - Suffix:
Authorized Official - Credentials:DO
Authorized Official - Phone:570-327-9900
Mailing Address - Street 1:904 CAMPBELL ST
Mailing Address - Street 2:SUITE 203
Mailing Address - City:WILLIAMSPORT
Mailing Address - State:PA
Mailing Address - Zip Code:17701-3166
Mailing Address - Country:US
Mailing Address - Phone:570-327-9900
Mailing Address - Fax:570-327-9400
Practice Address - Street 1:904 CAMPBELL ST
Practice Address - Street 2:SUITE 203
Practice Address - City:WILLIAMSPORT
Practice Address - State:PA
Practice Address - Zip Code:17701-3166
Practice Address - Country:US
Practice Address - Phone:570-327-9900
Practice Address - Fax:570-327-9400
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-07-05
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PA207VG0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207VG0400XAllopathic & Osteopathic PhysiciansObstetrics & GynecologyGynecologyGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
PA0017713190001Medicaid
PA672831Medicare ID - Type Unspecified