Provider Demographics
NPI:1134292584
Name:GASTROENTEROLOGY OF WEST CENTRAL OHIO, INC.
Entity Type:Organization
Organization Name:GASTROENTEROLOGY OF WEST CENTRAL OHIO, INC.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:ABDULLA
Authorized Official - Middle Name:
Authorized Official - Last Name:TAJA
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:419-228-3500
Mailing Address - Street 1:375 N EASTOWN RD
Mailing Address - Street 2:
Mailing Address - City:LIMA
Mailing Address - State:OH
Mailing Address - Zip Code:45807-2214
Mailing Address - Country:US
Mailing Address - Phone:419-228-3500
Mailing Address - Fax:419-228-6700
Practice Address - Street 1:375 N EASTOWN RD
Practice Address - Street 2:
Practice Address - City:LIMA
Practice Address - State:OH
Practice Address - Zip Code:45807-2214
Practice Address - Country:US
Practice Address - Phone:419-228-3500
Practice Address - Fax:419-228-6700
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-11-15
Last Update Date:2013-07-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH207RG0100X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207RG0100XAllopathic & Osteopathic PhysiciansInternal MedicineGastroenterologyGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
OH9366471Medicare PIN