Healthcare Provider Details

I. General information

NPI: 1912903287
Provider Name (Legal Business Name): DIGESTIVE CARE CONSULTANTS PC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 06/22/2005
Last Update Date: 11/03/2011
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

8775 NORWIN AVENUE
NORTH HUNTINGDON PA
15642-2718
US

IV. Provider business mailing address

585 RUGH STREET SUITE 202
GREENSBURG PA
15601-5667
US

V. Phone/Fax

Practice location:
  • Phone: 724-864-0503
  • Fax: 724-864-0535
Mailing address:
  • Phone: 724-838-1534
  • Fax: 724-838-1536

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207RG0100X
TaxonomyGastroenterology Physician
License Number077567
License Number StatePA

VIII. Authorized Official

Name: BALU SHETTY
Title or Position: PRESIDENT
Credential: MD
Phone: 724-864-0503