Provider Demographics
NPI:1871859579
Name:OBERLIN FOOT AND ANKLE LLC
Entity Type:Organization
Organization Name:OBERLIN FOOT AND ANKLE LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:AMANDA
Authorized Official - Middle Name:
Authorized Official - Last Name:MESZAROS
Authorized Official - Suffix:
Authorized Official - Credentials:DPM
Authorized Official - Phone:440-774-1100
Mailing Address - Street 1:PO BOX 22958
Mailing Address - Street 2:
Mailing Address - City:CLEVELAND
Mailing Address - State:OH
Mailing Address - Zip Code:44122-0958
Mailing Address - Country:US
Mailing Address - Phone:216-595-9600
Mailing Address - Fax:216-595-9601
Practice Address - Street 1:60 S PLEASANT ST
Practice Address - Street 2:SUITE A
Practice Address - City:OBERLIN
Practice Address - State:OH
Practice Address - Zip Code:44074-1683
Practice Address - Country:US
Practice Address - Phone:440-774-1100
Practice Address - Fax:440-774-4306
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2012-04-06
Last Update Date:2012-04-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH36003399213ES0103X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes213ES0103XPodiatric Medicine & Surgery Service ProvidersPodiatristFoot & Ankle SurgeryGroup - Single Specialty