MEDICARE: DIGESTIVE DISEASE CENTER OF OHIO VALLEY, INC

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	174400000X	Specialist	01545	WV

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number	:	1467513804
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	DIGESTIVE DISEASE CENTER OF OHIO VALLEY, INC

Provider Business Mailing Address
First Line	:	300 W MAIN ST
Second Line	:
City	:	SAINT CLAIRSVILLE
State	:	OH
Zip	:	43950-8801
Country	:	US
Telephone Number	:	740-968-7147
Fax Number	:	740-968-7144

Provider Business Practice Location Address
First Line	:	300 W MAIN ST
Second Line	:
City	:	SAINT CLAIRSVILLE
State	:	OH
Zip	:	43950-8801
Country	:	US
Telephone Number	:	740-968-7147
Fax Number	:	740-968-7144

Authorized Official
Title or Position	:	PRESIDENT
Name	:	SANJAY CHAUDHRY
Credential	:	M.D.
Telephone Number	:	740-633-4447

Provider Enumeration Date	:	12/12/2006
Last Update Date	:	08/29/2012

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