Provider Demographics
NPI:1114008299
Name:GASTROENTEROLOGY SPECIALIST
Entity Type:Organization
Organization Name:GASTROENTEROLOGY SPECIALIST
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:DOCTOR
Authorized Official - Prefix:
Authorized Official - First Name:CYNTHIA
Authorized Official - Middle Name:K
Authorized Official - Last Name:SATTERWHITE
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:757-826-6539
Mailing Address - Street 1:410 MARCELLA RD STE A
Mailing Address - Street 2:
Mailing Address - City:HAMPTON
Mailing Address - State:VA
Mailing Address - Zip Code:23666-2487
Mailing Address - Country:US
Mailing Address - Phone:757-826-6539
Mailing Address - Fax:
Practice Address - Street 1:410 MARCELLA RD
Practice Address - Street 2:SUITE A
Practice Address - City:HAMPTON
Practice Address - State:VA
Practice Address - Zip Code:23666-2487
Practice Address - Country:US
Practice Address - Phone:757-826-6539
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-10-17
Last Update Date:2009-03-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA0101032260207RG0100X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207RG0100XAllopathic & Osteopathic PhysiciansInternal MedicineGastroenterologyGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
VAB08647Medicare UPIN
VAC02827Medicare PIN