Healthcare Provider Details

I. General information

NPI: 1649530056
Provider Name (Legal Business Name): NEW TOWN OBSTETRICS & GYNECOLOGY LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 05/18/2012
Last Update Date: 05/18/2012
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2200 GRANT ST
GARY IN
46404-3439
US

IV. Provider business mailing address

2200 GRANT ST
GARY IN
46404-3439
US

V. Phone/Fax

Practice location:
  • Phone: 219-944-7565
  • Fax: 219-944-1304
Mailing address:
  • Phone: 219-944-7565
  • Fax: 219-944-1304

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207VG0400X
TaxonomyGynecology Physician
License Number01051456
License Number StateIN
# 2
Primary TaxonomyN
Taxonomy Code207VX0000X
TaxonomyObstetrics Physician
License Number0105456
License Number StateIN

VIII. Authorized Official

Name: DR. ANTHONY O IWUAGWU
Title or Position: PRESIDENT
Credential: M.D.
Phone: 219-944-7565