Basic Information
| Provider Information | |||||||||
| NPI: | 1740200260 | ||||||||
| EntityType: | 2 | ||||||||
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| OrganizationName: | ASSOCIATES OF OBSTERICS & GYNECOLOGY, PA | ||||||||
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| Mailing Information | |||||||||
| Address1: | 2801 SE 1ST AVE | ||||||||
| Address2: | SUITE 101 | ||||||||
| City: | OCALA | ||||||||
| State: | FL | ||||||||
| PostalCode: | 344710409 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 3526906300 | ||||||||
| FaxNumber: | 3526906802 | ||||||||
| Practice Location | |||||||||
| Address1: | 2801 SE 1ST AVE | ||||||||
| Address2: | SUITE 101 | ||||||||
| City: | OCALA | ||||||||
| State: | FL | ||||||||
| PostalCode: | 344710409 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 3526906300 | ||||||||
| FaxNumber: | 3526906802 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 07/20/2006 | ||||||||
| LastUpdateDate: | 09/02/2010 | ||||||||
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| AuthorizedOfficialLastName: | DELCHARCO | ||||||||
| AuthorizedOfficialFirstName: | MANUEL | ||||||||
| AuthorizedOfficialMiddleName: | F | ||||||||
| AuthorizedOfficialTitleorPosition: | PRESIDENT | ||||||||
| AuthorizedOfficialTelephone: | 3526906300 | ||||||||
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| IsOrganizationSubpart: | N | ||||||||
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| AuthorizedOfficialNamePrefix: | DR. | ||||||||
| AuthorizedOfficialNameSuffix: | JR. | ||||||||
| AuthorizedOfficialCredential: | MD | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 207VG0400X | ME0064539 | FL | Y | 193400000X MULTIPLE SINGLE SPECIALTY GROUP | Allopathic & Osteopathic Physicians | Obstetrics & Gynecology | Gynecology |
ID Information
| ID | Type | State | Issuer | Description | 255926900 | 05 | FL | MEDICAID |