Provider Demographics
NPI:1447466255
Name:OB-GYN ASSOCIATES OF ERIE PC
Entity type:Organization
Organization Name:OB-GYN ASSOCIATES OF ERIE PC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:BILLING SUPERVISOR
Authorized Official - Prefix:
Authorized Official - First Name:CHRISTINE
Authorized Official - Middle Name:D
Authorized Official - Last Name:DENOFRIO
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:814-459-1851
Mailing Address - Street 1:100 PEACH ST
Mailing Address - Street 2:SUITE 300
Mailing Address - City:ERIE
Mailing Address - State:PA
Mailing Address - Zip Code:16507-1423
Mailing Address - Country:US
Mailing Address - Phone:814-459-1851
Mailing Address - Fax:814-456-0541
Practice Address - Street 1:100 PEACH ST
Practice Address - Street 2:SUITE 300
Practice Address - City:ERIE
Practice Address - State:PA
Practice Address - Zip Code:16507-1423
Practice Address - Country:US
Practice Address - Phone:814-459-1851
Practice Address - Fax:814-456-0541
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-05-16
Last Update Date:2016-03-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes291U00000XLaboratoriesClinical Medical Laboratory
Provider Identifiers
StateIdentifier IDID TypeIssuer
PA1007431990013Medicaid