Healthcare Provider Details

I. General information

NPI: 1912905605
Provider Name (Legal Business Name): GASTROINTESTINAL CONSULTANTS OF NEPA
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 07/07/2005
Last Update Date: 06/19/2023
Certification Date: 06/19/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

517 ASH ST STE 1
SCRANTON PA
18509-2903
US

IV. Provider business mailing address

517 ASH ST STE 1
SCRANTON PA
18509-2903
US

V. Phone/Fax

Practice location:
  • Phone: 570-969-6100
  • Fax: 570-983-0267
Mailing address:
  • Phone: 570-969-6100
  • Fax: 570-983-0267

VI. Provider taxonomy

Scope of Practice (Provider specialty)

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

VII. Legacy identifiers

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

VIII. Authorized Official

Name: DAVID RUTTA
Title or Position: PRESIDENT
Credential: MD
Phone: 570-969-6100