Healthcare Provider Details

I. General information

NPI: 1013748581
Provider Name (Legal Business Name): DIGESTIVE DISEASE ASSOCIATES, LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 08/08/2024
Last Update Date: 05/16/2025
Certification Date: 05/16/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1220 E JOPPA RD STE 508
TOWSON MD
21286-5811
US

IV. Provider business mailing address

1220 E JOPPA RD STE 508
TOWSON MD
21286-5811
US

V. Phone/Fax

Practice location:
  • Phone: 410-296-4415
  • Fax:
Mailing address:
  • Phone: 410-296-4415
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code367500000X
TaxonomyCertified Registered Nurse Anesthetist
License Number
License Number State

VIII. Authorized Official

Name: ALAN OLIVER
Title or Position: CEO
Credential: CEO
Phone: 786-530-3820