Provider Demographics
NPI:1770779720
Name:WESTBROOK OB/GYN, INC.
Entity type:Organization
Organization Name:WESTBROOK OB/GYN, INC.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PHYSICIAN
Authorized Official - Prefix:
Authorized Official - First Name:VICTOR
Authorized Official - Middle Name:HIRAM
Authorized Official - Last Name:BAZZOLI
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:330-455-5231
Mailing Address - Street 1:2525 13TH ST NW
Mailing Address - Street 2:
Mailing Address - City:CANTON
Mailing Address - State:OH
Mailing Address - Zip Code:44708-3118
Mailing Address - Country:US
Mailing Address - Phone:330-455-5231
Mailing Address - Fax:330-455-1403
Practice Address - Street 1:2525 13TH ST NW
Practice Address - Street 2:
Practice Address - City:CANTON
Practice Address - State:OH
Practice Address - Zip Code:44708-3118
Practice Address - Country:US
Practice Address - Phone:330-455-5231
Practice Address - Fax:330-455-1403
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-09-23
Last Update Date:2008-07-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH174400000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes174400000XOther Service ProvidersSpecialistGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
OH0971104Medicaid
OHWE9264621OtherMEDICARE
OH000000163741OtherANTHEM
OH000000182566OtherUNISON
734099OtherBUCKEYE
OH104605OtherKAISER
OH2012181OtherHOMETOWN HEALTH
OHA74846Medicare UPIN