Healthcare Provider Details

I. General information

NPI: 1023075454
Provider Name (Legal Business Name): PENNSYLVANIA GASTROENTEROLOGY CONSULTANTS, PC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 04/28/2006
Last Update Date: 10/19/2021
Certification Date: 10/19/2021
Deactivation Date:
Reactivation Date:

III. Provider practice location address

899 POPLAR CHURCH RD
CAMP HILL PA
17011-2206
US

IV. Provider business mailing address

899 POPLAR CHURCH RD
CAMP HILL PA
17011-2206
US

V. Phone/Fax

Practice location:
  • Phone: 717-763-0430
  • Fax: 717-763-9854
Mailing address:
  • Phone: 717-763-0430
  • Fax: 717-763-9854

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207RG0100X
TaxonomyGastroenterology Physician
License Number
License Number State

VIII. Authorized Official

Name: IRIS A GARMAN
Title or Position: CORP SECRETARY
Credential:
Phone: 717-763-0430