Healthcare Provider Details

I. General information

NPI: 1366164618
Provider Name (Legal Business Name): KEYSTONE GI CONSULTANTS LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 09/14/2022
Last Update Date: 09/14/2022
Certification Date: 09/14/2022
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1019 ORIOLE CIR S
LOCK HAVEN PA
17745-8828
US

IV. Provider business mailing address

1019 ORIOLE CIR S
LOCK HAVEN PA
17745-8828
US

V. Phone/Fax

Practice location:
  • Phone: 570-660-1203
  • Fax:
Mailing address:
  • Phone: 570-660-1203
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

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

VII. Legacy identifiers

For crosswalk purposes, the following legacy (non-NPI) identifiers are available for this provider:

VIII. Authorized Official

Name: SAHIL R PATEL
Title or Position: PRESIDENT/OWNER
Credential:
Phone: 570-660-1203