Provider Demographics
NPI:1215023650
Name:MAUMEE BAY OBSTETRICS & GYNECOLOGY INC P A
Entity Type:Organization
Organization Name:MAUMEE BAY OBSTETRICS & GYNECOLOGY INC P A
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT/PHYSICIAN
Authorized Official - Prefix:
Authorized Official - First Name:MITCHELL
Authorized Official - Middle Name:GORDON
Authorized Official - Last Name:GREENBAUM
Authorized Official - Suffix:
Authorized Official - Credentials:DO
Authorized Official - Phone:419-691-8000
Mailing Address - Street 1:2702 NAVARRE AVE
Mailing Address - Street 2:SUITE 305
Mailing Address - City:OREGON
Mailing Address - State:OH
Mailing Address - Zip Code:43616-3223
Mailing Address - Country:US
Mailing Address - Phone:419-691-8000
Mailing Address - Fax:419-693-0111
Practice Address - Street 1:2702 NAVARRE AVE
Practice Address - Street 2:SUITE 305
Practice Address - City:OREGON
Practice Address - State:OH
Practice Address - Zip Code:43616-3223
Practice Address - Country:US
Practice Address - Phone:419-691-8000
Practice Address - Fax:419-693-0111
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-10-05
Last Update Date:2011-01-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207V00000XAllopathic & Osteopathic PhysiciansObstetrics & GynecologyGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
OH2290882Medicaid
OH9319381Medicare PIN