Healthcare Provider Details

I. General information

NPI: 1144595745
Provider Name (Legal Business Name): TUSCARAWAS COUNTY OB-GYN INC.
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 03/14/2012
Last Update Date: 10/03/2012
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

200 MEDICAL PARK DR SUITE B
DOVER OH
44622-2074
US

IV. Provider business mailing address

200 MEDICAL PARK DR SUITE B
DOVER OH
44622-2074
US

V. Phone/Fax

Practice location:
  • Phone: 330-343-0890
  • Fax: 330-343-0914
Mailing address:
  • Phone: 330-343-0890
  • Fax: 330-343-0914

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 Code261QM2500X
TaxonomyMedical Specialty Clinic/Center
License Number35-06-2669
License Number StateOH

VIII. Authorized Official

Name: DR. MARCEL N NWIZU
Title or Position: PRESIDENT
Credential: MD
Phone: 330-343-0890