Provider Demographics
NPI:1841648276
Name:EMERALD OBSTETRICS AND GYNECOLOGY LLC
Entity type:Organization
Organization Name:EMERALD OBSTETRICS AND GYNECOLOGY LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER PHYSICIAN
Authorized Official - Prefix:
Authorized Official - First Name:GENEVIEVE
Authorized Official - Middle Name:B
Authorized Official - Last Name:HAGERTY
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:614-875-0444
Mailing Address - Street 1:1241 DUBLIN RD
Mailing Address - Street 2:
Mailing Address - City:COLUMBUS
Mailing Address - State:OH
Mailing Address - Zip Code:43215-7048
Mailing Address - Country:US
Mailing Address - Phone:614-255-5349
Mailing Address - Fax:614-467-2010
Practice Address - Street 1:4461 BROADWAY
Practice Address - Street 2:SUITE 200
Practice Address - City:GROVE CITY
Practice Address - State:OH
Practice Address - Zip Code:43123-3064
Practice Address - Country:US
Practice Address - Phone:614-875-0444
Practice Address - Fax:614-875-1193
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2016-05-26
Last Update Date:2016-05-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH35077048207V00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207V00000XAllopathic & Osteopathic PhysiciansObstetrics & GynecologyGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
OH2342414Medicaid