Provider Demographics
NPI:1013073972
Name:LAWRENCE COUNTY OB GYN ASSOCIATES
Entity Type:Organization
Organization Name:LAWRENCE COUNTY OB GYN ASSOCIATES
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:RIFAAT
Authorized Official - Middle Name:R
Authorized Official - Last Name:BASSALY
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:724-652-2255
Mailing Address - Street 1:15 W WASHINGTON ST
Mailing Address - Street 2:OLDE POST OFFICE COMPLEX
Mailing Address - City:NEW CASTLE
Mailing Address - State:PA
Mailing Address - Zip Code:16101-3978
Mailing Address - Country:US
Mailing Address - Phone:724-652-2255
Mailing Address - Fax:724-652-2866
Practice Address - Street 1:15 W WASHINGTON ST
Practice Address - Street 2:OLDE POST OFFICE COMPLEX
Practice Address - City:NEW CASTLE
Practice Address - State:PA
Practice Address - Zip Code:16101-3978
Practice Address - Country:US
Practice Address - Phone:724-652-2255
Practice Address - Fax:724-652-2866
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-12-28
Last Update Date:2007-11-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PAMD031908LPA207V00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207V00000XAllopathic & Osteopathic PhysiciansObstetrics & GynecologyGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
PA0018404700001Medicaid
PA0018404700001Medicaid
PA046966Medicare PIN