Healthcare Provider Details
I. General information
NPI: 1245231505
Provider Name (Legal Business Name): GASTROINTESTINAL PHYSICIANS PC
Entity Type: Organization
Gender:
Sole Proprietor:
II. Dates (important events)
Enumeration Date: 08/09/2005
Last Update Date: 11/11/2009
Certification Date:
Deactivation Date:
Reactivation Date:
III. Provider practice location address
55 HIGHLAND AVE STE 304
SALEM MA
01970-2100
US
IV. Provider business mailing address
55 HIGHLAND AVE SUITE 304
SALEM MA
01970-2185
US
V. Phone/Fax
- Phone: 978-741-4171
- Fax: 978-741-4283
- Phone: 978-741-4171
- Fax: 978-741-4283
VI. Provider taxonomy
Scope of Practice (Provider specialty)
| # 1 | |
| Primary Taxonomy | Y |
| Taxonomy Code | 207RG0100X |
| Taxonomy | Gastroenterology Physician |
| License Number | |
| License Number State | |
VIII. Authorized Official
Name:
ALBERT
NAMIAS
Title or Position: PRESIDENT
Credential: MD
Phone: 978-741-4171