Provider Demographics
NPI:1518962547
Name:MARYSVILLE OBSTETRICS AND GYNECOLOGY INC.
Entity Type:Organization
Organization Name:MARYSVILLE OBSTETRICS AND GYNECOLOGY INC.
Other - Org Name:MARYSVILLE OBSTETRICS AND GYNECOLOGY INC.
Other - Org Type:Former Legal Business Name
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:FRANK
Authorized Official - Middle Name:R
Authorized Official - Last Name:RAYMOND
Authorized Official - Suffix:
Authorized Official - Credentials:DO
Authorized Official - Phone:937-644-2541
Mailing Address - Street 1:150 MOREY DR
Mailing Address - Street 2:
Mailing Address - City:MARYSVILLE
Mailing Address - State:OH
Mailing Address - Zip Code:43040-1646
Mailing Address - Country:US
Mailing Address - Phone:937-644-2541
Mailing Address - Fax:937-642-7535
Practice Address - Street 1:150 MOREY DR
Practice Address - Street 2:
Practice Address - City:MARYSVILLE
Practice Address - State:OH
Practice Address - Zip Code:43040-1646
Practice Address - Country:US
Practice Address - Phone:937-644-2541
Practice Address - Fax:937-642-7535
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2005-06-16
Last Update Date:2008-04-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes174400000XOther Service ProvidersSpecialistGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
OH=========OtherTAX ID NUMBER
OH9924643Medicare PIN
OH=========OtherTAX ID NUMBER