Healthcare Provider Details

I. General information

NPI: 1275703506
Provider Name (Legal Business Name): PARTNERS PHYSICIAN GROUP
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 03/03/2008
Last Update Date: 03/03/2008
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3300 GREENWICH RD
NORTON OH
44203-5714
US

IV. Provider business mailing address

3428 W MARKET ST #103
FAIRLAWN OH
44333-3339
US

V. Phone/Fax

Practice location:
  • Phone: 330-825-7371
  • Fax: 330-825-7473
Mailing address:
  • Phone: 330-344-3583
  • Fax: 330-869-2074

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code207RX0202X
TaxonomyMedical Oncology Physician
License Number
License Number StateOH
# 2
Primary TaxonomyY
Taxonomy Code207Q00000X
TaxonomyFamily Medicine Physician
License Number
License Number StateOH

VIII. Authorized Official

Name: DANIEL TAILLARD
Title or Position: DIRECTOR,FINANCE BUSINESS OPERATION
Credential:
Phone: 330-344-6095