Provider Demographics
NPI:1053483149
Name:OBSTETRICAL AND GYNECOLOGICAL ASSOCIATES OF AKRON INC
Entity Type:Organization
Organization Name:OBSTETRICAL AND GYNECOLOGICAL ASSOCIATES OF AKRON INC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRACTICE MANAGER
Authorized Official - Prefix:
Authorized Official - First Name:RACHEL
Authorized Official - Middle Name:CLARKE
Authorized Official - Last Name:GSELLMAN
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:330-668-6545
Mailing Address - Street 1:75 ARCH ST
Mailing Address - Street 2:STE 401
Mailing Address - City:AKRON
Mailing Address - State:OH
Mailing Address - Zip Code:44304-1429
Mailing Address - Country:US
Mailing Address - Phone:330-535-2689
Mailing Address - Fax:330-535-3815
Practice Address - Street 1:75 ARCH ST
Practice Address - Street 2:STE 401
Practice Address - City:AKRON
Practice Address - State:OH
Practice Address - Zip Code:44304-1429
Practice Address - Country:US
Practice Address - Phone:330-535-2689
Practice Address - Fax:330-535-3815
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-11-14
Last Update Date:2019-04-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH35035038P207V00000X
OH34006076C207V00000X
OH35080285O207V00000X
OH34004947207V00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207V00000XAllopathic & Osteopathic PhysiciansObstetrics & GynecologyGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
OH034069Medicaid
OHOB9264221Medicare ID - Type Unspecified