Provider Demographics
NPI:1053400507
Name:TOWPATH TRAIL FAMILY MEDICINE
Entity type:Organization
Organization Name:TOWPATH TRAIL FAMILY MEDICINE
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:GERTRUDE
Authorized Official - Middle Name:P
Authorized Official - Last Name:COTIAUX
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:330-879-5983
Mailing Address - Street 1:PO BOX 80690
Mailing Address - Street 2:
Mailing Address - City:CANTON
Mailing Address - State:OH
Mailing Address - Zip Code:44708
Mailing Address - Country:US
Mailing Address - Phone:330-833-5530
Mailing Address - Fax:330-833-6085
Practice Address - Street 1:1230 MARKET ST NE
Practice Address - Street 2:
Practice Address - City:NAVARRE
Practice Address - State:OH
Practice Address - Zip Code:44662
Practice Address - Country:US
Practice Address - Phone:330-879-5983
Practice Address - Fax:330-879-9527
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-10-12
Last Update Date:2008-06-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily MedicineGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
OH2813754Medicaid
OH2813754Medicaid
H10979Medicare UPIN