Healthcare Provider Details

I. General information

NPI: 1013004753
Provider Name (Legal Business Name): DIGESTIVE DISORDERS ASSOCIATES PC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 10/06/2006
Last Update Date: 05/29/2012
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

621 RIDGELY AVE SUITE 201
ANNAPOLIS MD
21401-1081
US

IV. Provider business mailing address

621 RIDGELY AVE SUITE 201
ANNAPOLIS MD
21401-1081
US

V. Phone/Fax

Practice location:
  • Phone: 410-266-1588
  • Fax: 410-266-6931
Mailing address:
  • Phone: 410-266-1588
  • Fax: 410-266-6931

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code174400000X
TaxonomySpecialist
License Number
License Number StateMD

VIII. Authorized Official

Name: MICHAEL S EPSTEIN
Title or Position: PRESIDENT
Credential: M.D.
Phone: 410-266-1588