Provider Demographics
NPI:1932192879
Name:BAYSIDE OBSTETRICS GYNECOLOGY AND INFERTILITY INC
Entity Type:Organization
Organization Name:BAYSIDE OBSTETRICS GYNECOLOGY AND INFERTILITY INC
Other - Org Name:BAYSIDE OB/GYN
Other - Org Type:Other Name
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:TIMOTHY
Authorized Official - Middle Name:J
Authorized Official - Last Name:WEIBEL
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:814-456-2229
Mailing Address - Street 1:104 E 2ND ST
Mailing Address - Street 2:3RD FLOOR
Mailing Address - City:ERIE
Mailing Address - State:PA
Mailing Address - Zip Code:16507-1532
Mailing Address - Country:US
Mailing Address - Phone:814-456-2229
Mailing Address - Fax:814-455-8635
Practice Address - Street 1:104 E 2ND ST
Practice Address - Street 2:3RD FLOOR
Practice Address - City:ERIE
Practice Address - State:PA
Practice Address - Zip Code:16507-1532
Practice Address - Country:US
Practice Address - Phone:814-456-2229
Practice Address - Fax:814-455-8635
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2005-08-25
Last Update Date:2009-09-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207V00000XAllopathic & Osteopathic PhysiciansObstetrics & GynecologyGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
PA0071495Medicare ID - Type Unspecified