Provider Demographics
NPI:1134332802
Name:OB-GYN ASSOCIATES OF WARREN, INC
Entity type:Organization
Organization Name:OB-GYN ASSOCIATES OF WARREN, INC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:ANTHONY
Authorized Official - Middle Name:R
Authorized Official - Last Name:DESALVO
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:330-856-7212
Mailing Address - Street 1:1842 E MARKET ST
Mailing Address - Street 2:
Mailing Address - City:WARREN
Mailing Address - State:OH
Mailing Address - Zip Code:44483-6638
Mailing Address - Country:US
Mailing Address - Phone:330-856-7212
Mailing Address - Fax:330-856-6101
Practice Address - Street 1:1842 E MARKET ST
Practice Address - Street 2:
Practice Address - City:WARREN
Practice Address - State:OH
Practice Address - Zip Code:44483-6638
Practice Address - Country:US
Practice Address - Phone:330-856-7212
Practice Address - Fax:330-856-6101
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-05-08
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH35071356207VX0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207VX0000XAllopathic & Osteopathic PhysiciansObstetrics & GynecologyObstetricsGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
DE08848831Medicare ID - Type Unspecified
H00434Medicare UPIN