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General NPI Number Information
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NPI Number | 1912941733
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Entity Type | Organization
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Legal Business Name | DIGESTIVE HEALTH ASSOCIATES P.C.
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Dates
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Enumeration Date | 06/15/2006
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Last Update Date | 08/22/2020
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Provider Practice Location Address
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Address Line | 955 MAIN ST
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City | WINCHESTER
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State | MA
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Zip | 01890-1961
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Country | US
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Telephone | 781-729-5855
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Fax | 781-721-5891
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Provider Business Mailing Address
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Address Line | 91 MONTVALE AVE
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City | STONEHAM
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State | MA
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Zip | 02180-3623
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Country | US
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Telephone | 781-729-5855
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Fax | 781-721-5891
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Authorized Official
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Title or Position | PRESIDENT
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Name | WILLIAM MOORE VANNEMAN
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Credential | M.D.
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Telephone | 781-729-5855
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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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