Healthcare Provider Details

I. General information

NPI: 1154497303
Provider Name (Legal Business Name): REPRODUCTIVE GYNECOLOGY LAB
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 11/28/2006
Last Update Date: 08/22/2020
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

95 ARCH ST STE 250
AKRON OH
44304
US

IV. Provider business mailing address

95 ARCH ST STE 250
AKRON OH
44304
US

V. Phone/Fax

Practice location:
  • Phone: 330-375-7722
  • Fax: 330-253-6708
Mailing address:
  • Phone: 330-375-7722
  • Fax: 330-253-6708

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207VE0102X
TaxonomyReproductive Endocrinology Physician
License Number
License Number State

VIII. Authorized Official

Name: DR. RICHARD W MORETUZZO
Title or Position: PHYSICIAN LAB OWNER
Credential: MD
Phone: 330-375-7722