Provider Demographics
NPI:1013004753
Name:DIGESTIVE DISORDERS ASSOCIATES PC
Entity Type:Organization
Organization Name:DIGESTIVE DISORDERS ASSOCIATES PC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:MICHAEL
Authorized Official - Middle Name:S
Authorized Official - Last Name:EPSTEIN
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:410-266-1588
Mailing Address - Street 1:621 RIDGELY AVE
Mailing Address - Street 2:SUITE 201
Mailing Address - City:ANNAPOLIS
Mailing Address - State:MD
Mailing Address - Zip Code:21401-1081
Mailing Address - Country:US
Mailing Address - Phone:410-266-1588
Mailing Address - Fax:410-266-6931
Practice Address - Street 1:621 RIDGELY AVE
Practice Address - Street 2:SUITE 201
Practice Address - City:ANNAPOLIS
Practice Address - State:MD
Practice Address - Zip Code:21401-1081
Practice Address - Country:US
Practice Address - Phone:410-266-1588
Practice Address - Fax:410-266-6931
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-10-06
Last Update Date:2012-05-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MD174400000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes174400000XOther Service ProvidersSpecialistGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
MDD65467Medicare UPIN
MDCJ3950Medicare PIN
MD155LMedicare PIN
MDD05906Medicare UPIN