Provider Demographics
NPI:1861433245
Name:WARREN OBSTETRICS AND GYNECOLOGY
Entity type:Organization
Organization Name:WARREN OBSTETRICS AND GYNECOLOGY
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER / M.D.
Authorized Official - Prefix:MR
Authorized Official - First Name:J. JOHN
Authorized Official - Middle Name:
Authorized Official - Last Name:MALJOVEC
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:814-723-8101
Mailing Address - Street 1:2265 MARKET ST
Mailing Address - Street 2:SUITE B
Mailing Address - City:WARREN
Mailing Address - State:PA
Mailing Address - Zip Code:16365-4668
Mailing Address - Country:US
Mailing Address - Phone:814-723-2323
Mailing Address - Fax:814-723-2024
Practice Address - Street 1:2265 MARKET ST
Practice Address - Street 2:SUITE B
Practice Address - City:WARREN
Practice Address - State:PA
Practice Address - Zip Code:16365-4668
Practice Address - Country:US
Practice Address - Phone:814-723-2323
Practice Address - Fax:814-723-2024
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-06-09
Last Update Date:2008-11-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes367A00000XPhysician Assistants & Advanced Practice Nursing ProvidersAdvanced Practice MidwifeGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
PA888043OtherBLUE CROSS BLUE SHIELD
PA476038Medicare PIN