Provider Demographics
NPI:1174562987
Name:SURGICAL ASSOCIATES OF MARIETTA
Entity type:Organization
Organization Name:SURGICAL ASSOCIATES OF MARIETTA
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:BRADLEY
Authorized Official - Middle Name:D
Authorized Official - Last Name:CARMAN
Authorized Official - Suffix:
Authorized Official - Credentials:DO FACOS
Authorized Official - Phone:740-374-2252
Mailing Address - Street 1:400 MATTHEW ST
Mailing Address - Street 2:SUITE 401
Mailing Address - City:MARIETTA
Mailing Address - State:OH
Mailing Address - Zip Code:45750-1662
Mailing Address - Country:US
Mailing Address - Phone:740-374-2252
Mailing Address - Fax:740-374-4974
Practice Address - Street 1:400 MATTHEW ST
Practice Address - Street 2:SUITE 401
Practice Address - City:MARIETTA
Practice Address - State:OH
Practice Address - Zip Code:45750-1662
Practice Address - Country:US
Practice Address - Phone:740-374-2252
Practice Address - Fax:740-374-4974
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-06-06
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes208600000XAllopathic & Osteopathic PhysiciansSurgeryGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
OH2034873Medicaid
OH2034873Medicaid