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General NPI Number Information
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NPI Number | 1710940507
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Entity Type | Organization
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Legal Business Name | HILLSIDE GASTROENTEROLOGY & NUTRTION, INC
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Dates
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Enumeration Date | 04/11/2006
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Last Update Date | 03/14/2008
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Provider Practice Location Address
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Address Line | 250 FAME AVE SUITE 201
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City | HANOVER
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State | PA
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Zip | 17331-1587
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Country | US
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Telephone | 717-633-9086
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Fax | 717-633-9379
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Provider Business Mailing Address
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Address Line | 250 FAME AVE SUITE 201
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City | HANOVER
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State | PA
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Zip | 17331-1587
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Country | US
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Telephone | 717-633-9086
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Fax | 717-633-9379
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Authorized Official
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Title or Position | PHYSICIAN/OWNER
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Name | PAUL D THOMAS
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Credential | DO
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Telephone | 717-633-9086
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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 | OS006926L
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License Number State | PA
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