Provider Demographics
NPI:1922081652
Name:FOSTORIA MEDICAL ASSOCIATES INC
Entity Type:Organization
Organization Name:FOSTORIA MEDICAL ASSOCIATES INC
Other - Org Name:MED-LINK CLINIC
Other - Org Type:Doing Business As
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:MR
Authorized Official - First Name:M
Authorized Official - Middle Name:DAVID
Authorized Official - Last Name:LALI
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:419-436-9091
Mailing Address - Street 1:709 N VINE ST
Mailing Address - Street 2:
Mailing Address - City:FOSTORIA
Mailing Address - State:OH
Mailing Address - Zip Code:44830-1552
Mailing Address - Country:US
Mailing Address - Phone:419-436-9091
Mailing Address - Fax:419-436-9094
Practice Address - Street 1:709 N VINE ST
Practice Address - Street 2:
Practice Address - City:FOSTORIA
Practice Address - State:OH
Practice Address - Zip Code:44830-1552
Practice Address - Country:US
Practice Address - Phone:419-436-9091
Practice Address - Fax:419-436-9094
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2005-11-28
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH35070837207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal MedicineGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
OHFO9346171Medicare ID - Type Unspecified