Healthcare Provider Details

I. General information

NPI: 1407400955
Provider Name (Legal Business Name): DIGESTIVE DISEASE ASSOCIATES, LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 08/01/2019
Last Update Date: 05/16/2025
Certification Date: 05/16/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

700 GEIPE ROAD STE 230
BALTIMORE MD
21228-4176
US

IV. Provider business mailing address

700 GEIPE ROAD STE 201
BALTIMORE MD
21228-4176
US

V. Phone/Fax

Practice location:
  • Phone: 410-247-7500
  • Fax: 410-247-4227
Mailing address:
  • Phone: 410-737-9741
  • Fax: 410-737-6884

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code207L00000X
TaxonomyAnesthesiology Physician
License Number
License Number State
# 2
Primary TaxonomyY
Taxonomy Code207RG0100X
TaxonomyGastroenterology Physician
License Number
License Number State
# 3
Primary TaxonomyN
Taxonomy Code207RT0003X
TaxonomyTransplant Hepatology Physician
License Number
License Number State
# 4
Primary TaxonomyN
Taxonomy Code207ZP0102X
TaxonomyAnatomic Pathology & Clinical Pathology Physician
License Number
License Number State

VIII. Authorized Official

Name: ALAN OLIVER
Title or Position: CEO
Credential: CEO
Phone: 745-372-3055