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General NPI Number Information
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NPI Number | 1669481016
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Entity Type | Organization
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Legal Business Name | SOUTHERN OHIO GASTROENTEROLOGY INC
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Dates
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Enumeration Date | 08/05/2006
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Last Update Date | 07/28/2015
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Provider Practice Location Address
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Address Line | 8101 HAYPORT RD
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City | WHEELERSBURG
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State | OH
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Zip | 45694-1769
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Country | US
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Telephone | 740-355-8562
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Fax | 740-355-7149
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Provider Business Mailing Address
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Address Line | PO BOX 428
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City | WHEELERSBURG
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State | OH
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Zip | 45694-0428
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Country | US
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Telephone | 740-355-8562
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Fax | 740-355-7149
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Authorized Official
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Title or Position | OWNER
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Name | DR. RESHMA BANERJEE-KATARIA
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Credential | DO
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Telephone | 740-355-8562
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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 | 34008464
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License Number State | OH
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