Provider Demographics
NPI:1124016381
Name:KEYSTONE DIGESTIVE DISORDER CONSULTANTS, PC
Entity Type:Organization
Organization Name:KEYSTONE DIGESTIVE DISORDER CONSULTANTS, PC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:ROBERT
Authorized Official - Middle Name:
Authorized Official - Last Name:KANIA
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:412-681-1616
Mailing Address - Street 1:4815 LIBERTY AVE
Mailing Address - Street 2:SUITE M58
Mailing Address - City:PITTSBURGH
Mailing Address - State:PA
Mailing Address - Zip Code:15224-2156
Mailing Address - Country:US
Mailing Address - Phone:412-681-1616
Mailing Address - Fax:412-681-6438
Practice Address - Street 1:4815 LIBERTY AVE
Practice Address - Street 2:SUITE M58
Practice Address - City:PITTSBURGH
Practice Address - State:PA
Practice Address - Zip Code:15224-2156
Practice Address - Country:US
Practice Address - Phone:412-681-1616
Practice Address - Fax:412-681-6438
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2005-10-12
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207RG0100XAllopathic & Osteopathic PhysiciansInternal MedicineGastroenterologyGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
PA435343Medicare ID - Type Unspecified