Organization
MEDCORP OF STARK COUNTY, INC.
Active
Organization subpart
No
Provider details
NPI number
Authorized official
DR. DEBORAH D WILSON (OFFICE MANAGER)
(330) 833-8996
Entity
Organization
Contact information
Practice address
2500 WALES AVE NW, MASSILLON, OH 44646-2324
(330) 833-8996
(330) 833-6969
Mailing address
2500 WALES AVE NW, MASSILLON, OH 44646-2324
(330) 833-8996
(330) 833-6969
Taxonomy
Speciality
Code
Description
License number
State
207R00000X
Internal Medicine Physician
Primary
—
—
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
0559908
—
OH
01
—
9918911
MEDICARE ID NUMBER
OH
Enumeration date
02/09/2006
Last updated
07/28/2009
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