Provider Demographics
NPI:1780869909
Name:AVAMAR GASTROENTEROLOGY, INC.
Entity type:Organization
Organization Name:AVAMAR GASTROENTEROLOGY, INC.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OFFICE MANAGER
Authorized Official - Prefix:MRS
Authorized Official - First Name:BARBARA
Authorized Official - Middle Name:E
Authorized Official - Last Name:STEINBECK
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:330-372-7470
Mailing Address - Street 1:9225 E MARKET ST
Mailing Address - Street 2:
Mailing Address - City:WARREN
Mailing Address - State:OH
Mailing Address - Zip Code:44484-5517
Mailing Address - Country:US
Mailing Address - Phone:330-372-7470
Mailing Address - Fax:330-372-7480
Practice Address - Street 1:9225 E MARKET ST
Practice Address - Street 2:
Practice Address - City:WARREN
Practice Address - State:OH
Practice Address - Zip Code:44484-5517
Practice Address - Country:US
Practice Address - Phone:330-372-7470
Practice Address - Fax:330-372-7480
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2008-01-07
Last Update Date:2010-11-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207RG0100XAllopathic & Osteopathic PhysiciansInternal MedicineGastroenterologyGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
OHFA0630683Medicare PIN