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General NPI Number Information
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NPI Number | 1972235737
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Entity Type | Organization
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Legal Business Name | DOXOLOGY HEALTH AND FERTILITY LLC
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Dates
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Enumeration Date | 06/29/2022
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Last Update Date | 10/07/2022
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Provider Practice Location Address
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Address Line | 1197 HIGH ST STE 100
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City | WADSWORTH
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State | OH
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Zip | 44281-8282
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Country | US
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Telephone | 330-529-9229
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Fax |
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Provider Business Mailing Address
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Address Line | 1197 HIGH ST STE 102
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City | WADSWORTH
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State | OH
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Zip | 44281-8282
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Country | US
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Telephone | 330-529-9229
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Fax |
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Authorized Official
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Title or Position | MEMBER
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Name | SUMMER T HOLMES MASON
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Credential | MD
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Telephone | 443-994-6889
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 207Q00000X
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Taxonomy Name | Family Medicine 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 | 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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