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NPI Code Detail

MEDICARE: GASTROENTEROLOGY ASSOCIATES INC

MEDICARE: GASTROENTEROLOGY ASSOCIATES 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
1207RG0100XGastroenterology Physician

Other Identifiers

# Provider Identifier Provider Identifier Type Provider Identifier State Provider Identifier Issuer
1MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number : 1184779639
Entity Type Code : Organization
Provider Name (Legal Business Name) : GASTROENTEROLOGY ASSOCIATES INC
Provider Business Mailing Address
First Line : PO BOX 36329
Second Line :
City : CANTON
State : OH
Zip : 44735-6329
Country : US
Telephone Number : 330-493-1480
Fax Number : 330-493-6805
Provider Business Practice Location Address
First Line : 4665 BELPAR ST NW
Second Line :
City : CANTON
State : OH
Zip : 44718-3602
Country : US
Telephone Number : 330-493-1480
Fax Number : 330-493-6805
Authorized Official
Title or Position : DOCTOR
Name : SANJIV KHETARPAL
Credential : MD
Telephone Number : 330-493-1480
Provider Enumeration Date : 01/24/2007
Last Update Date : 08/22/2020

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Directions to “GASTROENTEROLOGY ASSOCIATES INC ” Practice Location

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