Provider Demographics
NPI:1952483612
Name:OB-GYN SERVICES, P.C.
Entity Type:Organization
Organization Name:OB-GYN SERVICES, P.C.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRACTICE MANAGER
Authorized Official - Prefix:
Authorized Official - First Name:BRIDGET
Authorized Official - Middle Name:
Authorized Official - Last Name:LANDRY
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:860-886-2461
Mailing Address - Street 1:17 CASE ST
Mailing Address - Street 2:
Mailing Address - City:NORWICH
Mailing Address - State:CT
Mailing Address - Zip Code:06360-2214
Mailing Address - Country:US
Mailing Address - Phone:860-886-2461
Mailing Address - Fax:860-887-8530
Practice Address - Street 1:17 CASE ST
Practice Address - Street 2:
Practice Address - City:NORWICH
Practice Address - State:CT
Practice Address - Zip Code:06360-2214
Practice Address - Country:US
Practice Address - Phone:860-886-2461
Practice Address - Fax:860-887-8530
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-10-20
Last Update Date:2007-11-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207V00000XAllopathic & Osteopathic PhysiciansObstetrics & GynecologyGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
CTC00295Medicare ID - Type Unspecified