Provider Demographics
NPI:1356606123
Name:EAST WEST OBGYN
Entity type:Organization
Organization Name:EAST WEST OBGYN
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:MARCO
Authorized Official - Middle Name:
Authorized Official - Last Name:MOREL
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:860-561-3557
Mailing Address - Street 1:836 FARMINGTON AVE. S. 211
Mailing Address - Street 2:
Mailing Address - City:WEST HARTFORD
Mailing Address - State:CT
Mailing Address - Zip Code:06119
Mailing Address - Country:US
Mailing Address - Phone:860-561-3557
Mailing Address - Fax:860-523-0454
Practice Address - Street 1:836 FARMINGTON AVE. S. 211
Practice Address - Street 2:
Practice Address - City:WEST HARTFORD
Practice Address - State:CT
Practice Address - Zip Code:06119
Practice Address - Country:US
Practice Address - Phone:860-561-3557
Practice Address - Fax:860-523-0454
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2012-07-09
Last Update Date:2012-07-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207VG0400XAllopathic & Osteopathic PhysiciansObstetrics & GynecologyGynecologyGroup - Single Specialty