Provider Demographics
NPI:1376732636
Name:GASTROENTEROLOGY OF AKRON, INC.
Entity Type:Organization
Organization Name:GASTROENTEROLOGY OF AKRON, INC.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER/PHYSICIAN
Authorized Official - Prefix:
Authorized Official - First Name:MANZOOR
Authorized Official - Middle Name:
Authorized Official - Last Name:QADIR
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:330-535-3313
Mailing Address - Street 1:PO BOX 713056
Mailing Address - Street 2:
Mailing Address - City:CINCINNATI
Mailing Address - State:OH
Mailing Address - Zip Code:45271
Mailing Address - Country:US
Mailing Address - Phone:330-535-3313
Mailing Address - Fax:330-535-1907
Practice Address - Street 1:3939 S. CLEVELAND-MASSILLON RD
Practice Address - Street 2:
Practice Address - City:NORTON
Practice Address - State:OH
Practice Address - Zip Code:44203-5611
Practice Address - Country:US
Practice Address - Phone:330-535-3313
Practice Address - Fax:330-535-1907
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-10-23
Last Update Date:2008-09-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH35-06-8779207RG0100X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207RG0100XAllopathic & Osteopathic PhysiciansInternal MedicineGastroenterologyGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
OH0154265Medicaid
OH9329601Medicare PIN