MEDICARE: DIGESTIVE DISEASE CONSULTANTS INC

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	207RG0100X	Gastroenterology Physician	017952E	PA

General Provider Information

NPI Number	:	1124095765
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	DIGESTIVE DISEASE CONSULTANTS INC

Provider Business Mailing Address
First Line	:	301 FIRST AVENUE
Second Line	:
City	:	TARENTUM
State	:	PA
Zip	:	15084-1858
Country	:	US
Telephone Number	:	724-224-3113
Fax Number	:	724-224-2447

Provider Business Practice Location Address
First Line	:	301 FIRST AVENUE
Second Line	:
City	:	TARENTUM
State	:	PA
Zip	:	15084-1858
Country	:	US
Telephone Number	:	724-224-3113
Fax Number	:	724-224-2447

Authorized Official
Title or Position	:	MD
Name	:	H DAVID LIPSITZ
Credential	:
Telephone Number	:	724-224-3113

Provider Enumeration Date	:	03/02/2006
Last Update Date	:	08/22/2020

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