Provider Demographics
NPI:1093321382
Name:CHARLOTTE HARBOR GASTROENTEROLOGY LLC
Entity Type:Organization
Organization Name:CHARLOTTE HARBOR GASTROENTEROLOGY LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CHAIRMAN
Authorized Official - Prefix:
Authorized Official - First Name:ANTHONY
Authorized Official - Middle Name:
Authorized Official - Last Name:DITOMASO
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:941-757-4810
Mailing Address - Street 1:2811 TAMIAMI TRL STE I
Mailing Address - Street 2:
Mailing Address - City:PORT CHARLOTTE
Mailing Address - State:FL
Mailing Address - Zip Code:33952-5135
Mailing Address - Country:US
Mailing Address - Phone:941-483-5730
Mailing Address - Fax:941-483-5740
Practice Address - Street 1:2811 TAMIAMI TRL STE I
Practice Address - Street 2:
Practice Address - City:PORT CHARLOTTE
Practice Address - State:FL
Practice Address - Zip Code:33952-5135
Practice Address - Country:US
Practice Address - Phone:941-483-5730
Practice Address - Fax:941-483-5740
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:FLORIDA DIGESTIVE HEALTH SPECIALISTS LLP
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2020-09-22
Last Update Date:2023-06-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207RG0100XAllopathic & Osteopathic PhysiciansInternal MedicineGastroenterologyGroup - Single Specialty