Provider Demographics
NPI:1972599561
Name:DAYTON OB-GYN INC
Entity type:Organization
Organization Name:DAYTON OB-GYN INC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT/CEO
Authorized Official - Prefix:MR
Authorized Official - First Name:AHMAD
Authorized Official - Middle Name:
Authorized Official - Last Name:MOEZZI
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:937-439-7553
Mailing Address - Street 1:330 N MAIN ST
Mailing Address - Street 2:DAYTON OB-BYN INC
Mailing Address - City:CENTERVILLE
Mailing Address - State:OH
Mailing Address - Zip Code:45459-4465
Mailing Address - Country:US
Mailing Address - Phone:937-439-7553
Mailing Address - Fax:937-439-7561
Practice Address - Street 1:330 N MAIN ST
Practice Address - Street 2:DAYTON OB-GYN INC
Practice Address - City:CENTERVILLE
Practice Address - State:OH
Practice Address - Zip Code:45459-4465
Practice Address - Country:US
Practice Address - Phone:937-439-7553
Practice Address - Fax:937-439-7561
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2005-09-20
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Not Answered207VG0400XAllopathic & Osteopathic PhysiciansObstetrics & GynecologyGynecologyGroup - Single Specialty
Not Answered207VX0000XAllopathic & Osteopathic PhysiciansObstetrics & GynecologyObstetricsGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
OHDA9925672Medicare ID - Type Unspecified