Healthcare Provider Details

I. General information

NPI: 1649202045
Provider Name (Legal Business Name): GASTROENTEROLOGISTS LTD
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 07/07/2006
Last Update Date: 02/20/2023
Certification Date: 02/20/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1339 WOODBOURNE RD
LEVITTOWN PA
19057-1236
US

IV. Provider business mailing address

1339 WOODBOURNE RD STE B101
LEVITTOWN PA
19057-1236
US

V. Phone/Fax

Practice location:
  • Phone: 215-547-3441
  • Fax: 215-547-7172
Mailing address:
  • Phone: 215-945-0647
  • Fax: 215-547-7172

VI. Provider taxonomy

Scope of Practice (Provider specialty)

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

VIII. Authorized Official

Name: MRS. LAURA A HAMILTON
Title or Position: ADMINISTRATOR/MANAGER
Credential:
Phone: 215-945-0647