Provider Demographics
NPI:1164643508
Name:ADVANCED OBGYN CARE
Entity Type:Organization
Organization Name:ADVANCED OBGYN CARE
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:IACOB
Authorized Official - Middle Name:
Authorized Official - Last Name:MARCOVICI
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:860-409-1930
Mailing Address - Street 1:35 NOD RD STE 201B
Mailing Address - Street 2:
Mailing Address - City:AVON
Mailing Address - State:CT
Mailing Address - Zip Code:06001-3826
Mailing Address - Country:US
Mailing Address - Phone:860-409-1930
Mailing Address - Fax:
Practice Address - Street 1:35 NOD RD STE 201B
Practice Address - Street 2:
Practice Address - City:AVON
Practice Address - State:CT
Practice Address - Zip Code:06001-3826
Practice Address - Country:US
Practice Address - Phone:860-409-1930
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-05-02
Last Update Date:2007-10-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CT041940207VG0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207VG0400XAllopathic & Osteopathic PhysiciansObstetrics & GynecologyGynecologyGroup - Single Specialty