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General NPI Number Information
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NPI Number | 1417993833
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Entity Type | Organization
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Legal Business Name | GASTROENTEROLOGY CONSULTANTS OF
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Dates
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Enumeration Date | 06/22/2006
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Last Update Date | 08/09/2018
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Provider Practice Location Address
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Address Line | 202 DUKE OF GLOUCHESTER ST
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City | ROANOKE
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State | VA
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Zip | 24014
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Country | US
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Telephone | 540-345-4900
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Fax | 540-345-4179
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Provider Business Mailing Address
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Address Line | 202 DUKE OF GLOUCESTER ST SW
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City | ROANOKE
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State | VA
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Zip | 24014-1372
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Country | US
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Telephone | 540-345-4900
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Fax | 540-345-4179
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Authorized Official
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Title or Position | ADMINISTRATOR
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Name | DIANE LYNN ALLISON
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Credential |
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Telephone | 540-510-3324
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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 |
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