Healthcare Provider Details

I. General information

NPI: 1023347499
Provider Name (Legal Business Name): WILLIAM M. QUIRK, M.D., FACOG, OBSTETRICS AND GYNECOLOGY, LLC.
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 12/15/2009
Last Update Date: 09/22/2014
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

5533 MAHONING AVE SUITE D
AUSTINTOWN OH
44515-2366
US

IV. Provider business mailing address

5533 MAHONING AVE SUITE D
AUSTINTOWN OH
44515-2366
US

V. Phone/Fax

Practice location:
  • Phone: 330-793-7966
  • Fax: 330-953-3963
Mailing address:
  • Phone: 330-793-7966
  • Fax: 330-953-3963

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207V00000X
TaxonomyObstetrics & Gynecology Physician
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code207VF0040X
TaxonomyUrogynecology and Reconstructive Pelvic Surgery (Obstetrics & Gynecology) Physician
License Number35063544
License Number StateOH

VIII. Authorized Official

Name: MELISSA QUIRK
Title or Position: OFFICE MANAGER
Credential:
Phone: 330-793-7699