Provider Demographics
NPI:1174632434
Name:GYN-OB CONS GR CINTI INC
Entity Type:Organization
Organization Name:GYN-OB CONS GR CINTI INC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:NPI CONTACT DR
Authorized Official - Prefix:
Authorized Official - First Name:STEWART
Authorized Official - Middle Name:J
Authorized Official - Last Name:FRIEDMAN
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:513-792-5800
Mailing Address - Street 1:2123 AUBURN AVENUE
Mailing Address - Street 2:SUITE 528
Mailing Address - City:CINCINNATI
Mailing Address - State:OH
Mailing Address - Zip Code:45219
Mailing Address - Country:US
Mailing Address - Phone:513-792-5800
Mailing Address - Fax:513-792-5806
Practice Address - Street 1:2123 AUBURN AVENUE
Practice Address - Street 2:SUITE 528
Practice Address - City:CINCINNATI
Practice Address - State:OH
Practice Address - Zip Code:45219
Practice Address - Country:US
Practice Address - Phone:513-792-5800
Practice Address - Fax:513-792-5806
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-08-30
Last Update Date:2013-05-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH207V00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207V00000XAllopathic & Osteopathic PhysiciansObstetrics & GynecologyGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
OH0910970001OtherMEIDCARE SUPPLIER
OH0499410Medicaid
KY65918021Medicaid
OH0499410Medicaid