Provider Demographics
NPI:1366637217
Name:CONSTANTINE G ECONOMUS MD LLC
Entity Type:Organization
Organization Name:CONSTANTINE G ECONOMUS MD LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:CONSTANTINE
Authorized Official - Middle Name:G
Authorized Official - Last Name:ECONOMUS
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:330-884-2400
Mailing Address - Street 1:7641 MARKET ST
Mailing Address - Street 2:SUITE 3
Mailing Address - City:YOUNGSTOWN
Mailing Address - State:OH
Mailing Address - Zip Code:44512-6010
Mailing Address - Country:US
Mailing Address - Phone:330-884-2400
Mailing Address - Fax:
Practice Address - Street 1:7641 MARKET ST
Practice Address - Street 2:SUITE 3
Practice Address - City:YOUNGSTOWN
Practice Address - State:OH
Practice Address - Zip Code:44512-6010
Practice Address - Country:US
Practice Address - Phone:330-884-2400
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-09-12
Last Update Date:2013-02-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207V00000XAllopathic & Osteopathic PhysiciansObstetrics & GynecologyGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
OHDD9087OtherPALMETTO GBA RETIRED
OH9352841Medicare PIN