Healthcare Provider Details

I. General information

NPI: 1801826177
Provider Name (Legal Business Name): PHILADELPHIA GASTROENTEROLOGY GROUP, P.C.
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 07/03/2006
Last Update Date: 02/14/2017
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

525 JAMESTOWN ST SUITE 101
PHILADELPHIA PA
19128-1751
US

IV. Provider business mailing address

525 JAMESTOWN ST SUITE 101
PHILADELPHIA PA
19128-1751
US

V. Phone/Fax

Practice location:
  • Phone: 215-463-1483
  • Fax: 215-483-9185
Mailing address:
  • Phone: 215-463-1483
  • Fax: 215-483-9185

VI. Provider taxonomy

Scope of Practice (Provider specialty)

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

VIII. Authorized Official

Name: ANNAMARIE ANDREWS
Title or Position: OFFICE MANAGER
Credential:
Phone: 215-463-1483