Provider Demographics
NPI:1265528335
Name:GYNECOLOGIC ONCOLOGISTS OF NORTHEASTERN OHIO, INC.
Entity type:Organization
Organization Name:GYNECOLOGIC ONCOLOGISTS OF NORTHEASTERN OHIO, INC.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:ADMINISTRATOR
Authorized Official - Prefix:MRS
Authorized Official - First Name:DEBORAH
Authorized Official - Middle Name:J
Authorized Official - Last Name:CUGINI
Authorized Official - Suffix:
Authorized Official - Credentials:CMM
Authorized Official - Phone:330-344-2072
Mailing Address - Street 1:224 W EXCHANGE ST
Mailing Address - Street 2:SUITE 140
Mailing Address - City:AKRON
Mailing Address - State:OH
Mailing Address - Zip Code:44302-1704
Mailing Address - Country:US
Mailing Address - Phone:330-344-6656
Mailing Address - Fax:330-344-6449
Practice Address - Street 1:224 W EXCHANGE ST
Practice Address - Street 2:SUITE #140
Practice Address - City:AKRON
Practice Address - State:OH
Practice Address - Zip Code:44302-1704
Practice Address - Country:US
Practice Address - Phone:330-344-6041
Practice Address - Fax:330-344-6449
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-10-05
Last Update Date:2009-02-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207VX0201XAllopathic & Osteopathic PhysiciansObstetrics & GynecologyGynecologic OncologyGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
OH0752930Medicaid
OH0752930Medicaid