MEDICARE: MARYSVILLE OBSTETRICS AND GYNECOLOGY INC.

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	174400000X	Specialist

General Provider Information

NPI Number	:	1518962547
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	MARYSVILLE OBSTETRICS AND GYNECOLOGY INC.

Provider Business Mailing Address
First Line	:	150 MOREY DR
Second Line	:
City	:	MARYSVILLE
State	:	OH
Zip	:	43040-1646
Country	:	US
Telephone Number	:	937-644-2541
Fax Number	:	937-642-7535

Provider Business Practice Location Address
First Line	:	150 MOREY DR
Second Line	:
City	:	MARYSVILLE
State	:	OH
Zip	:	43040-1646
Country	:	US
Telephone Number	:	937-644-2541
Fax Number	:	937-642-7535

Authorized Official
Title or Position	:	PRESIDENT
Name	:	DR. FRANK R. RAYMOND
Credential	:	DO
Telephone Number	:	937-644-2541

Provider Enumeration Date	:	06/16/2005
Last Update Date	:	04/20/2008

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