1659453033 NPI number — DR. MARY BETH SPITZNAGEL PHD

Table of content: DR. MARY BETH SPITZNAGEL PHD (NPI 1659453033)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1659453033 NPI number — DR. MARY BETH SPITZNAGEL PHD

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
SPITZNAGEL
Provider First Name:
MARY
Provider Middle Name:
BETH
Provider Name Prefix Text:
DR.
Provider Name Suffix Text:
Provider Credential Text:
PHD
Provider Gender Code:
F

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:
1659453033
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
11/22/2011
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
PO BOX 1462
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
STOW
Provider Business Mailing Address State Name:
OH
Provider Business Mailing Address Postal Code:
44224-0462
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
330-379-8148
Provider Business Mailing Address Fax Number:
330-379-8149

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
75 ARCH ST
Provider Second Line Business Practice Location Address:
SUITE G2
Provider Business Practice Location Address City Name:
AKRON
Provider Business Practice Location Address State Name:
OH
Provider Business Practice Location Address Postal Code:
44304-1429
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
330-375-3747
Provider Business Practice Location Address Fax Number:
330-375-4939
Provider Enumeration Date:
10/19/2006

Additional Information

Authorized Official

Authorized Official Last Name:
Authorized Official First Name:
Authorized Official Middle Name:
Authorized Official Title or Position:
Authorized Official Telephone Number:

Provider Taxonomy Codes

  • Taxonomy code: 103G00000X , with the licence number:  6123 , 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: 2877552 , issued by the state of ( OH ) . This identifiers is of the category "MEDICAID".




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