Healthcare Provider Details

I. General information

NPI: 1821192816
Provider Name (Legal Business Name): GI MEDICAL ASSOCIATES
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 09/11/2006
Last Update Date: 10/31/2013
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

23 N LANSDOWNE AVE
LANSDOWNE PA
19050
US

IV. Provider business mailing address

23 N LANSDOWNE AVE
LANSDOWNE PA
19050
US

V. Phone/Fax

Practice location:
  • Phone: 610-626-4397
  • Fax:
Mailing address:
  • Phone: 610-626-4397
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207R00000X
TaxonomyInternal Medicine Physician
License NumberMD012611E
License Number StatePA
# 2
Primary TaxonomyN
Taxonomy Code311Z00000X
TaxonomyCustodial Care Facility
License NumberMD012611E
License Number StatePA

VIII. Authorized Official

Name: DR. GEORGE ISAJIW
Title or Position: PRESIDENT
Credential: MD
Phone: 610-626-4397