Provider Demographics
NPI:1861426876
Name:ALL ABOUT WOMEN, PA
Entity type:Organization
Organization Name:ALL ABOUT WOMEN, PA
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:SUSAN
Authorized Official - Middle Name:LOVEJOY
Authorized Official - Last Name:ROQUE
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:704-658-1413
Mailing Address - Street 1:170 MEDICAL PARK RD
Mailing Address - Street 2:SUITE 301
Mailing Address - City:MOORESVILLE
Mailing Address - State:NC
Mailing Address - Zip Code:28117-8540
Mailing Address - Country:US
Mailing Address - Phone:704-658-1413
Mailing Address - Fax:704-658-1431
Practice Address - Street 1:170 MEDICAL PARK RD
Practice Address - Street 2:SUITE 301
Practice Address - City:MOORESVILLE
Practice Address - State:NC
Practice Address - Zip Code:28117-8540
Practice Address - Country:US
Practice Address - Phone:704-658-1413
Practice Address - Fax:704-658-1431
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-07-10
Last Update Date:2010-01-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC95-00440207V00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207V00000XAllopathic & Osteopathic PhysiciansObstetrics & GynecologyGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
NC8973089Medicaid
NC8973089Medicaid
NC2324061Medicare PIN