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General NPI Number Information
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NPI Number | 1295772861
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Entity Type | Organization
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Legal Business Name | BAYFRONT DIGESTIVE DISEASE ASSOCIATES PC
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Dates
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Enumeration Date | 06/01/2006
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Last Update Date | 11/13/2009
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Provider Practice Location Address
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Address Line | 100 PEACH ST SUITE 200
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City | ERIE
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State | PA
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Zip | 16507-1411
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Country | US
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Telephone | 814-456-7733
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Fax | 814-456-7213
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Provider Business Mailing Address
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Address Line | 100 PEACH ST SUITE 200
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City | ERIE
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State | PA
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Zip | 16507-1411
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Country | US
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Telephone | 814-456-7733
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Fax | 814-456-7213
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Authorized Official
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Title or Position | PRACTICE ADMINISTRATOR
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Name | MRS. TINA M CASILLO
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Credential |
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Telephone | 814-456-7733
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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 |
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License Number State | PA
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