Provider Demographics
NPI:1659110898
Name:CONSTANTINE V. ECONOMOUS M.D. LLC
Entity type:Organization
Organization Name:CONSTANTINE V. ECONOMOUS M.D. LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:CONSTANTINE
Authorized Official - Middle Name:V
Authorized Official - Last Name:ECONOMOUS
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:330-332-9961
Mailing Address - Street 1:2370 SOUTHEAST BLVD
Mailing Address - Street 2:
Mailing Address - City:SALEM
Mailing Address - State:OH
Mailing Address - Zip Code:44460-3418
Mailing Address - Country:US
Mailing Address - Phone:330-332-9961
Mailing Address - Fax:330-337-3282
Practice Address - Street 1:2370 SOUTHEAST BLVD
Practice Address - Street 2:
Practice Address - City:SALEM
Practice Address - State:OH
Practice Address - Zip Code:44460-3418
Practice Address - Country:US
Practice Address - Phone:330-332-9961
Practice Address - Fax:330-337-3282
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2024-05-20
Last Update Date:2024-05-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily MedicineGroup - Single Specialty