Provider Demographics
NPI:1417933136
Name:OBERLIN INTERNAL MEDICINE ASSOCIATES INC
Entity Type:Organization
Organization Name:OBERLIN INTERNAL MEDICINE ASSOCIATES INC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:MGR
Authorized Official - Prefix:MS
Authorized Official - First Name:DONNA
Authorized Official - Middle Name:A
Authorized Official - Last Name:JENNINGS
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:440-774-5248
Mailing Address - Street 1:224 W LORAIN ST
Mailing Address - Street 2:STE A
Mailing Address - City:OBERLIN
Mailing Address - State:OH
Mailing Address - Zip Code:44074
Mailing Address - Country:US
Mailing Address - Phone:440-774-5248
Mailing Address - Fax:440-774-6006
Practice Address - Street 1:224 W LORAIN ST
Practice Address - Street 2:SUITE A
Practice Address - City:OBERLIN
Practice Address - State:OH
Practice Address - Zip Code:44074
Practice Address - Country:US
Practice Address - Phone:440-774-5248
Practice Address - Fax:440-774-6006
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2005-12-15
Last Update Date:2012-03-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal MedicineGroup - Single Specialty