Healthcare Provider Details

I. General information

NPI: 1700336583
Provider Name (Legal Business Name): TIBERIU AVRAM MD PC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 10/05/2016
Last Update Date: 01/25/2017
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3020 N MCCORD RD SUITE 201A
TOLEDO OH
43615-1744
US

IV. Provider business mailing address

3020 N MCCORD RD SUITE 201A
TOLEDO OH
43615-1744
US

V. Phone/Fax

Practice location:
  • Phone: 419-450-0045
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207V00000X
TaxonomyObstetrics & Gynecology Physician
License Number35.087285
License Number StateOH

VIII. Authorized Official

Name: TIBERIU AVRAM
Title or Position: PRESIDENT
Credential: M.D.
Phone: 419-450-0045