Provider Demographics
NPI:1356463384
Name:DICKINSON OB-GYN ASSOCIATION, P.A.
Entity Type:Organization
Organization Name:DICKINSON OB-GYN ASSOCIATION, P.A.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:MICHAEL
Authorized Official - Middle Name:ANTHONY
Authorized Official - Last Name:MAGLIOLO
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:281-334-6875
Mailing Address - Street 1:2450 S SHORE BLVD
Mailing Address - Street 2:SUITE 215
Mailing Address - City:LEAGUE CITY
Mailing Address - State:TX
Mailing Address - Zip Code:77573-2994
Mailing Address - Country:US
Mailing Address - Phone:281-334-6875
Mailing Address - Fax:281-334-0664
Practice Address - Street 1:2450 S SHORE BLVD
Practice Address - Street 2:SUITE 215
Practice Address - City:LEAGUE CITY
Practice Address - State:TX
Practice Address - Zip Code:77573-2994
Practice Address - Country:US
Practice Address - Phone:281-334-6875
Practice Address - Fax:281-334-0664
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-04-03
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207V00000XAllopathic & Osteopathic PhysiciansObstetrics & GynecologyGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX00PM31Medicare ID - Type UnspecifiedMEDICARE ID#