Provider Demographics
NPI:1467946285
Name:TRI STATE OBSTETRICS & GYNECOLOGY
Entity Type:Organization
Organization Name:TRI STATE OBSTETRICS & GYNECOLOGY
Other - Org Name:GENERATIONS OB/GYN
Other - Org Type:Doing Business As
Authorized Official - Title/Position:PRESIDENT & CEO
Authorized Official - Prefix:MR
Authorized Official - First Name:NORMAN
Authorized Official - Middle Name:F
Authorized Official - Last Name:MITRY
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:724-773-4776
Mailing Address - Street 1:1000 DUTCH RIDGE RD
Mailing Address - Street 2:
Mailing Address - City:BEAVER
Mailing Address - State:PA
Mailing Address - Zip Code:15009-9727
Mailing Address - Country:US
Mailing Address - Phone:724-773-4776
Mailing Address - Fax:724-773-4726
Practice Address - Street 1:3468 BRODHEAD RD STE 12
Practice Address - Street 2:
Practice Address - City:MONACA
Practice Address - State:PA
Practice Address - Zip Code:15061-3149
Practice Address - Country:US
Practice Address - Phone:724-728-3575
Practice Address - Fax:724-770-7964
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:TRI STATE OBSTETRICS & GYNECOLOGY
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2018-06-15
Last Update Date:2022-07-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207V00000XAllopathic & Osteopathic PhysiciansObstetrics & GynecologyGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
PA001548632Medicaid