Provider Demographics
NPI:1083701825
Name:NORTH PARK OB/GYN ASSOCIATION
Entity Type:Organization
Organization Name:NORTH PARK OB/GYN ASSOCIATION
Other - Org Name:WOMEN'S IMAGING NORTH
Other - Org Type:Doing Business As
Authorized Official - Title/Position:OFFICE MANAGER
Authorized Official - Prefix:MISS
Authorized Official - First Name:MARY
Authorized Official - Middle Name:CATHERINE
Authorized Official - Last Name:RUGGIERO
Authorized Official - Suffix:
Authorized Official - Credentials:RN
Authorized Official - Phone:724-934-9344
Mailing Address - Street 1:9000 BROOKTREE RD
Mailing Address - Street 2:SUITE 402
Mailing Address - City:WEXFORD
Mailing Address - State:PA
Mailing Address - Zip Code:15090-9255
Mailing Address - Country:US
Mailing Address - Phone:724-934-9344
Mailing Address - Fax:724-934-9343
Practice Address - Street 1:9000 BROOKTREE RD
Practice Address - Street 2:SUITE 402
Practice Address - City:WEXFORD
Practice Address - State:PA
Practice Address - Zip Code:15090-9255
Practice Address - Country:US
Practice Address - Phone:724-934-9344
Practice Address - Fax:724-934-9343
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:NORTH PARK OB/GYN ASSOCIATION
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2006-10-05
Last Update Date:2008-03-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes2085R0202XAllopathic & Osteopathic PhysiciansRadiologyDiagnostic RadiologyGroup - Single Specialty
No2085U0001XAllopathic & Osteopathic PhysiciansRadiologyDiagnostic UltrasoundGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
804059Medicare PIN