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General NPI Number Information
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NPI Number | 1104834126
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Entity Type | Organization
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Legal Business Name | DIGESTIVE DISEASE ASSOCIATES, LLP
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Dates
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Enumeration Date | 08/04/2006
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Last Update Date | 09/30/2015
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Provider Practice Location Address
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Address Line | 1561 LONG POND RD STE 110
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City | ROCHESTER
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State | NY
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Zip | 14626
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Country | US
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Telephone | 585-723-1510
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Fax | 585-723-1518
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Provider Business Mailing Address
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Address Line | 1561 LONG POND RD STE 110
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City | ROCHESTER
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State | NY
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Zip | 14626
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Country | US
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Telephone | 585-723-1510
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Fax | 585-723-1518
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Authorized Official
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Title or Position | DR PARTNER
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Name | DR. KARL T MERSICH
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Credential | MD
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Telephone | 585-723-1510
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 207RG0100X
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Taxonomy Name | Gastroenterology Physician
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License Number | 177994
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License Number State | NY
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