Provider Demographics
NPI:1164696647
Name:OB GYN & ENDOSCOPY OF CARROLL COUNTY, LLC
Entity Type:Organization
Organization Name:OB GYN & ENDOSCOPY OF CARROLL COUNTY, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OFFICER
Authorized Official - Prefix:DR
Authorized Official - First Name:MICHAEL
Authorized Official - Middle Name:
Authorized Official - Last Name:VIETZ
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:410-876-7049
Mailing Address - Street 1:1380 PROGRESS WAY STE 107
Mailing Address - Street 2:
Mailing Address - City:ELDERSBURG
Mailing Address - State:MD
Mailing Address - Zip Code:21784-6498
Mailing Address - Country:US
Mailing Address - Phone:410-876-7049
Mailing Address - Fax:410-795-7054
Practice Address - Street 1:1380 PROGRESS WAY STE 107
Practice Address - Street 2:
Practice Address - City:ELDERSBURG
Practice Address - State:MD
Practice Address - Zip Code:21784-6498
Practice Address - Country:US
Practice Address - Phone:410-876-7049
Practice Address - Fax:410-795-7054
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2008-04-16
Last Update Date:2008-04-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207V00000XAllopathic & Osteopathic PhysiciansObstetrics & GynecologyGroup - Single Specialty