Healthcare Provider Details

I. General information

NPI: 1730822404
Provider Name (Legal Business Name): NEIGHBORHOOD MEDICAL INCORPORATED
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 04/19/2022
Last Update Date: 04/19/2022
Certification Date: 04/19/2022
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1515 E MARKET ST
WARREN OH
44483-6641
US

IV. Provider business mailing address

1457 CENTRAL PARKWAY AVE SE
WARREN OH
44484-4458
US

V. Phone/Fax

Practice location:
  • Phone: 330-271-8486
  • Fax: 330-662-6601
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207Q00000X
TaxonomyFamily Medicine Physician
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code207R00000X
TaxonomyInternal Medicine Physician
License Number
License Number State
# 3
Primary TaxonomyN
Taxonomy Code2083P0901X
TaxonomyPublic Health & General Preventive Medicine Physician
License Number
License Number State
# 4
Primary TaxonomyN
Taxonomy Code208M00000X
TaxonomyHospitalist Physician
License Number
License Number State

VIII. Authorized Official

Name: MR. DANDRE L BOWERS
Title or Position: MEDICAL SERVICES DIRECTOR & CEO
Credential:
Phone: 330-406-9690