Healthcare Provider Details

I. General information

NPI: 1750444832
Provider Name (Legal Business Name): OBERLIN PEDIATRICS INC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 12/19/2006
Last Update Date: 08/22/2020
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

224 WEST LORAIN ST SUITE E
OBERLIN OH
44074
US

IV. Provider business mailing address

224 WEST LORAIN ST SUITE E
OBERLIN OH
44074
US

V. Phone/Fax

Practice location:
  • Phone: 440-774-7337
  • Fax:
Mailing address:
  • Phone: 440-774-7337
  • Fax: 440-774-7327

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code208000000X
TaxonomyPediatrics Physician
License Number
License Number State

VIII. Authorized Official

Name: MRS. JEAN F DOMBROSKY
Title or Position: OFFICE MANAGER
Credential:
Phone: 440-774-7337