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General NPI Number Information
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NPI Number | 1861721219
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Entity Type | Organization
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Legal Business Name | NORTHEAST OHIO BARIATRIC MEDICINE, LLC
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Dates
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Enumeration Date | 12/14/2009
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Last Update Date | 06/26/2013
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Provider Practice Location Address
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Address Line | 890 WOOSTER RD
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City | MILLERSBURG
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State | OH
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Zip | 44654-1033
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Country | US
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Telephone | 330-473-4525
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Fax | 800-673-5340
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Provider Business Mailing Address
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Address Line | 890 WOOSTER RD
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City | MILLERSBURG
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State | OH
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Zip | 44654-1033
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Country | US
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Telephone | 330-473-4525
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Fax | 800-673-5340
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Authorized Official
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Title or Position | OWNER
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Name | DR. ROBERT HART
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Credential | M.D.
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Telephone | 330-473-4525
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 261QM2500X
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Taxonomy Name | Medical Specialty Clinic/Center
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License Number | 35053793
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License Number State | OH
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