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General NPI Number Information
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NPI Number | 1568419281
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Entity Type | Organization
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Legal Business Name | TRI STATE OBSTETRICS & GYNECOLOGY
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Dates
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Enumeration Date | 05/28/2006
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Last Update Date | 07/08/2024
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Provider Practice Location Address
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Address Line | 2580 CONSTITUTION BLVD
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City | BEAVER FALLS
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State | PA
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Zip | 15010-1294
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Country | US
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Telephone | 724-843-0737
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Fax | 724-770-7922
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Provider Business Mailing Address
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Address Line | 2 PEARTREE WAY
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City | BEAVER
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State | PA
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Zip | 15009-1954
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Country | US
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Telephone | 724-773-6802
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Fax | 724-770-7919
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Authorized Official
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Title or Position | PRESIDENT AND CEO
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Name | NORMAN F MITRY
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Credential |
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Telephone | 724-773-4776
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 207VG0400X
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Taxonomy Name | Gynecology Physician
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License Number |
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License Number State |
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Taxonomy #2
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Taxonomy Code | 207VX0000X
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Taxonomy Name | Obstetrics Physician
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License Number |
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License Number State |
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Taxonomy #3
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Taxonomy Code | 207V00000X
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Taxonomy Name | Obstetrics & Gynecology Physician
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License Number |
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License Number State |
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