Organization Active NPI

Marietta Gynecologic Associates, Inc.

  • Obstetrics & Gynecology Physician
  • Marietta, OH
National Provider Identifier
1720165202
Registry record updated Jan 22, 2008
On this page

Key facts

NPPES NPI Registry
Primary specialty
Obstetrics & Gynecology PhysicianTaxonomy code 207V00000X
License
N/A
Legal business name
MARIETTA GYNECOLOGIC ASSOCIATES, INC.
Practice address
410 2ND St
Marietta, OH 45750-2115
Phone
(740) 374-3622
Fax
(740) 374-4209
NPI assigned
Nov 1, 2006
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Jan 22, 2008

Registry information is reported by the provider to CMS and is not verified. About this source

Authorized official

Name
Ms. Karen E Lines
Title
Practice Adminstrator
Phone
(740) 374-3622

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Obstetrics & Gynecology PhysicianGroup: 193400000X SINGLE SPECIALTY GROUP 207V00000X N/A Primary

Addresses

Primary practice location

410 2ND St
Marietta, OH 45750-2115

Mailing address

410 2ND St
Marietta, OH 45750-2115
Phone (740) 374-3622

Other identifiers 2

IdentifierTypeStateIssuer
0006831000MedicaidOH
0006831000MedicaidWV

National Provider Directory

National Provider Directory

Practitioners & affiliated clinicians

Practitioners 3

Individual providers connected to this organization through Medicare benefit reassignment, Care Compare group membership or National Provider Directory roles.

NPI Registry JSON

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1162339200000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1200960000000",
    "number": "1720165202",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "410 2ND ST",
            "city": "MARIETTA",
            "state": "OH",
            "postal_code": "457502115",
            "telephone_number": "740-374-3622",
            "fax_number": "740-374-4209"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "410 2ND ST",
            "city": "MARIETTA",
            "state": "OH",
            "postal_code": "457502115",
            "telephone_number": "740-374-3622",
            "fax_number": "740-374-4209"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "MARIETTA GYNECOLOGIC ASSOCIATES, INC.",
        "organizational_subpart": "NO",
        "enumeration_date": "2006-11-01",
        "last_updated": "2008-01-22",
        "status": "A",
        "authorized_official_last_name": "LINES",
        "authorized_official_first_name": "KAREN",
        "authorized_official_middle_name": "E",
        "authorized_official_title_or_position": "PRACTICE ADMINSTRATOR",
        "authorized_official_telephone_number": "740-374-3622",
        "authorized_official_name_prefix": "Ms."
    },
    "taxonomies": [
        {
            "code": "207V00000X",
            "taxonomy_group": "193400000X SINGLE SPECIALTY  GROUP",
            "desc": "Obstetrics & Gynecology",
            "state": null,
            "license": "N/A",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "0006831000",
            "state": "OH"
        },
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "0006831000",
            "state": "WV"
        }
    ],
    "endpoints": [],
    "other_names": []
}

Other providers in Marietta, OH

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jan 22, 2008; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
  • National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.