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General NPI Number Information
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NPI Number | 1124179171
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Entity Type | Organization
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Legal Business Name | GASTROENTEROLOGY OF CANTON INC
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Dates
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Enumeration Date | 01/16/2007
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Last Update Date | 08/12/2014
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Provider Practice Location Address
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Address Line | 4124 MUNSON ST NW SUITE A
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City | CANTON
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State | OH
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Zip | 44718-2979
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Country | US
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Telephone | 330-492-6662
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Fax | 330-492-6918
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Provider Business Mailing Address
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Address Line | 4124 MUNSON ST NW SUITE A
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City | CANTON
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State | OH
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Zip | 44718-2979
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Country | US
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Telephone | 330-492-6662
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Fax | 330-492-6918
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Authorized Official
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Title or Position | OFFICE MANAGER
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Name | MS. SHARI TOWNSEND
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Credential |
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Telephone | 330-492-6662
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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 | 35046973
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License Number State | OH
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