Provider Demographics
NPI:1396019527
Name:REPRODUCTIVE GYNECOLOGY LABS COLUMBUS LLC
Entity Type:Organization
Organization Name:REPRODUCTIVE GYNECOLOGY LABS COLUMBUS LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:RICHARD
Authorized Official - Middle Name:W
Authorized Official - Last Name:MORETUZZO
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:330-375-7722
Mailing Address - Street 1:95 ARCH ST
Mailing Address - Street 2:STE 250
Mailing Address - City:AKRON
Mailing Address - State:OH
Mailing Address - Zip Code:44304
Mailing Address - Country:US
Mailing Address - Phone:330-375-7722
Mailing Address - Fax:330-253-6708
Practice Address - Street 1:540 N. CLEVELAND AVE
Practice Address - Street 2:STE 100
Practice Address - City:WESTERVILLE
Practice Address - State:OH
Practice Address - Zip Code:43082
Practice Address - Country:US
Practice Address - Phone:614-895-3333
Practice Address - Fax:614-895-3338
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2012-03-06
Last Update Date:2012-03-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH350421094M207VE0102X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207VE0102XAllopathic & Osteopathic PhysiciansObstetrics & GynecologyReproductive EndocrinologyGroup - Single Specialty