1700958964 NPI number — ANN MARIE STUART MD LLC

Table of content: LIGIA LIANA TOFANEL FNP (NPI 1578075081)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1700958964 NPI number — ANN MARIE STUART MD LLC

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
ANN MARIE STUART MD LLC
Provider Last Name:
Provider First Name:
Provider Middle Name:
Provider Name Prefix Text:
Provider Name Suffix Text:
Provider Credential Text:
Provider Gender Code:

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
Provider Other Last Name:
Provider Other First Name:
Provider Other Middle Name:
Provider Other Name Prefix Text:
Provider Other Name Suffix Text:
Provider Other Credential Text:
Provider Other Last Name Type Code:

NPI Number Information

NPI Number:
1700958964
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
08/22/2020
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
970 E WASHINGTON STREET
Provider Second Line Business Mailing Address:
STE 5A
Provider Business Mailing Address City Name:
MEDINA
Provider Business Mailing Address State Name:
OH
Provider Business Mailing Address Postal Code:
44256
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
330-721-8500
Provider Business Mailing Address Fax Number:
330-721-8510

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
970 E WASHINGTON STREET
Provider Second Line Business Practice Location Address:
STE 5A
Provider Business Practice Location Address City Name:
MEDINA
Provider Business Practice Location Address State Name:
OH
Provider Business Practice Location Address Postal Code:
44256
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
330-721-8500
Provider Business Practice Location Address Fax Number:
330-721-8510
Provider Enumeration Date:
11/14/2006

Additional Information

Authorized Official

Authorized Official Last Name:
STUART
Authorized Official First Name:
ANN MARIE
Authorized Official Middle Name:
Authorized Official Title or Position:
PHYSICIAN
Authorized Official Telephone Number:
330-721-8500

Provider Taxonomy Codes

  • Taxonomy code: 207Q00000X , with the licence number:  35080891S , registered in the state of OH ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

Other Provider's Identifiers (legacy, non-NPI)

  • Identifier: 2335413 , issued by the state of ( OH ) . This identifiers is of the category "MEDICAID".




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