Organization
MARYMOUNT PRIMARY CARE SERVICES, INC
Active
Organization subpart
No
Provider details
NPI number
Authorized official
PETER P WALCHANOWICZ (PRACTICE MANAGER)
(440) 543-8855
Entity
Organization
Contact information
Practice address
34501 AURORA RD, SUITE 101, SOLON, OH 44139-3873
(440) 914-0960
Mailing address
34501 AURORA RD, SUITE 101, SOLON, OH 44139-3873
Taxonomy
Speciality
Code
Description
License number
State
207V00000X
Obstetrics & Gynecology Physician
Primary
—
—
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
000000564024
ANTHEM
OH
05
—
2088940
—
OH
Enumeration date
08/09/2007
Last updated
05/27/2008
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