Healthcare Provider Details

I. General information

NPI: 1962602680
Provider Name (Legal Business Name): FAR HILLS OB GYN INC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 07/20/2007
Last Update Date: 01/20/2022
Certification Date: 01/20/2022
Deactivation Date:
Reactivation Date:

III. Provider practice location address

5701 FAR HILLS AVE
DAYTON OH
45429-2207
US

IV. Provider business mailing address

5701 FAR HILLS AVE
DAYTON OH
45429-2207
US

V. Phone/Fax

Practice location:
  • Phone: 937-435-6222
  • Fax: 937-438-8451
Mailing address:
  • Phone: 937-435-6222
  • Fax: 937-438-8451

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207V00000X
TaxonomyObstetrics & Gynecology Physician
License Number207VX0000X
License Number StateOH

VIII. Authorized Official

Name: MRS. PAM S PALMER
Title or Position: PRACTICE ADMINISTRATOR
Credential:
Phone: 937-435-6222