Healthcare Provider Details

I. General information

NPI: 1245354356
Provider Name (Legal Business Name): APPALACHIAN GASTROENTEROLOGY PA
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 03/16/2007
Last Update Date: 08/22/2020
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

870 STATE FARM RD SUITE 102
BOONE NC
28607-4861
US

IV. Provider business mailing address

870 STATE FARM RD SUITE 102
BOONE NC
28607-4861
US

V. Phone/Fax

Practice location:
  • Phone: 828-264-0029
  • Fax: 828-265-3305
Mailing address:
  • Phone: 828-264-0029
  • Fax: 828-265-3305

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code261QE0800X
TaxonomyEndoscopy Clinic/Center
License Number
License Number State

VIII. Authorized Official

Name: DOUGLAS M TRATE
Title or Position: OWNER
Credential: M.D.
Phone: 828-264-0029