Provider Demographics
NPI:1285634709
Name:ASHTABULA PULMONARY ASSOCIATES INC
Entity Type:Organization
Organization Name:ASHTABULA PULMONARY ASSOCIATES INC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:TREASURER
Authorized Official - Prefix:MRS
Authorized Official - First Name:KATI
Authorized Official - Middle Name:
Authorized Official - Last Name:MOLINOFF
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:440-275-3433
Mailing Address - Street 1:PO BOX 1435
Mailing Address - Street 2:
Mailing Address - City:ASHTABULA
Mailing Address - State:OH
Mailing Address - Zip Code:44005-1435
Mailing Address - Country:US
Mailing Address - Phone:440-275-3433
Mailing Address - Fax:440-275-3031
Practice Address - Street 1:2121 LAKE AVE
Practice Address - Street 2:
Practice Address - City:ASHTABULA
Practice Address - State:OH
Practice Address - Zip Code:44004-3435
Practice Address - Country:US
Practice Address - Phone:440-998-4775
Practice Address - Fax:440-998-5922
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2005-07-27
Last Update Date:2010-02-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH084570207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal MedicineGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
OH0541962Medicaid
OH50055OtherSTATE MEDICAL BOARD
AS9329941Medicare ID - Type Unspecified
OH50055OtherSTATE MEDICAL BOARD