Healthcare Provider Details

I. General information

NPI: 1902804982
Provider Name (Legal Business Name): GASTROENTEROLOGY ASSOCIATES, PA
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 07/13/2005
Last Update Date: 08/22/2020
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

4745 OGLETOWN STANTON RD 134
NEWARK DE
19713-2067
US

IV. Provider business mailing address

4745 OGLETOWN STANTON RD 134
NEWARK DE
19713-2067
US

V. Phone/Fax

Practice location:
  • Phone: 302-738-5300
  • Fax: 302-731-4822
Mailing address:
  • Phone: 302-738-5300
  • Fax: 302-731-4822

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code174400000X
TaxonomySpecialist
License NumberC1-0003750
License Number StateDE

VIII. Authorized Official

Name: DR. WARREN G. BUTT
Title or Position: PRESIDENT
Credential: MD
Phone: 302-738-5300