Provider Demographics
NPI:1013037555
Name:GASTROENTEROLOGY ASSOCIATES OF THE SHENANDOAH VALLEY, INC
Entity Type:Organization
Organization Name:GASTROENTEROLOGY ASSOCIATES OF THE SHENANDOAH VALLEY, INC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:DAVID
Authorized Official - Middle Name:L
Authorized Official - Last Name:FISHKIN
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:304-263-8200
Mailing Address - Street 1:2010 DOCTOR OATES DR
Mailing Address - Street 2:SUITE 103
Mailing Address - City:MARTINSBURG
Mailing Address - State:WV
Mailing Address - Zip Code:25401-8896
Mailing Address - Country:US
Mailing Address - Phone:304-263-8200
Mailing Address - Fax:304-263-9242
Practice Address - Street 1:2010 DOCTOR OATES DR
Practice Address - Street 2:SUITE 103
Practice Address - City:MARTINSBURG
Practice Address - State:WV
Practice Address - Zip Code:25401-8896
Practice Address - Country:US
Practice Address - Phone:304-263-8200
Practice Address - Fax:304-263-9242
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-03-29
Last Update Date:2007-10-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WV17136174400000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes174400000XOther Service ProvidersSpecialistGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
1639297781OtherNPI
WV6050031Medicaid
MDD 45418OtherMD LINCENSE
WV17136OtherMD LINCENSE
MDO88QMedicare PIN
1639297781OtherNPI
WV0731642Medicare PIN