Provider Demographics
NPI:1649465733
Name:COMMUNITY MEDICAL ASSOCIATES
Entity type:Organization
Organization Name:COMMUNITY MEDICAL ASSOCIATES
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:BILLING MANAGER
Authorized Official - Prefix:MRS
Authorized Official - First Name:TERRI
Authorized Official - Middle Name:
Authorized Official - Last Name:DINGER
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:330-792-7495
Mailing Address - Street 1:1450 S CANFIELD NILES RD
Mailing Address - Street 2:
Mailing Address - City:YOUNGSTOWN
Mailing Address - State:OH
Mailing Address - Zip Code:44515-4083
Mailing Address - Country:US
Mailing Address - Phone:330-792-7495
Mailing Address - Fax:330-792-7842
Practice Address - Street 1:1450 S CANFIELD NILES RD
Practice Address - Street 2:
Practice Address - City:YOUNGSTOWN
Practice Address - State:OH
Practice Address - Zip Code:44515-4083
Practice Address - Country:US
Practice Address - Phone:330-792-7495
Practice Address - Fax:330-792-7842
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-09-11
Last Update Date:2007-09-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal MedicineGroup - Single Specialty
No207Q00000XAllopathic & Osteopathic PhysiciansFamily MedicineGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
OH2588203Medicaid
OH2588203Medicaid