Healthcare Provider Details

I. General information

NPI: 1598728024
Provider Name (Legal Business Name): MEADVILLE OBSTETRICS AND GYNECOLOGY ASSOCIATES
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 04/07/2006
Last Update Date: 12/02/2011
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

765 LIBERTY STREET SUITE 202
MEADVILLE PA
16335
US

IV. Provider business mailing address

765 LIBERTY STREET SUITE 202
MEADVILLE PA
16335
US

V. Phone/Fax

Practice location:
  • Phone: 814-333-5888
  • Fax: 814-333-5026
Mailing address:
  • Phone: 814-333-5888
  • Fax: 814-333-5026

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207V00000X
TaxonomyObstetrics & Gynecology Physician
License Number
License Number State

VIII. Authorized Official

Name: SIDNEY KWOKYIN KING
Title or Position: PRESIDENT
Credential: MD
Phone: 814-333-5888