Provider Demographics
NPI:1609141829
Name:BAY AREA ADVANCED OBGYN, PLLC
Entity type:Organization
Organization Name:BAY AREA ADVANCED OBGYN, PLLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:MD
Authorized Official - Prefix:
Authorized Official - First Name:ERWIN
Authorized Official - Middle Name:MANFRED
Authorized Official - Last Name:KORMAN
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:832-331-1125
Mailing Address - Street 1:450 W MEDICAL CENTER BLVD STE 410
Mailing Address - Street 2:
Mailing Address - City:WEBSTER
Mailing Address - State:TX
Mailing Address - Zip Code:77598-4233
Mailing Address - Country:US
Mailing Address - Phone:832-331-1125
Mailing Address - Fax:281-724-1077
Practice Address - Street 1:450 W MEDICAL CENTER BLVD STE 410
Practice Address - Street 2:
Practice Address - City:WEBSTER
Practice Address - State:TX
Practice Address - Zip Code:77598-4233
Practice Address - Country:US
Practice Address - Phone:832-331-1125
Practice Address - Fax:281-724-1077
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:BAY AREA ADVANCED OBGYN, PLLC
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2012-03-21
Last Update Date:2013-03-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TXF4912207V00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207V00000XAllopathic & Osteopathic PhysiciansObstetrics & GynecologyGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX308874201Medicaid
TX099377603Medicaid
TX114825604Medicaid
TXC18015Medicare UPIN
TXA14235Medicare UPIN
TX308874201Medicaid