Provider Demographics
NPI:1164432449
Name:DIGESTIVE DISEASE ASSOCIATES, P.A.
Entity Type:Organization
Organization Name:DIGESTIVE DISEASE ASSOCIATES, P.A.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:C.E.O.
Authorized Official - Prefix:
Authorized Official - First Name:CHARLES
Authorized Official - Middle Name:
Authorized Official - Last Name:ZORN
Authorized Official - Suffix:
Authorized Official - Credentials:MBA
Authorized Official - Phone:410-247-7500
Mailing Address - Street 1:700 GEIPE RD
Mailing Address - Street 2:SUITE 201
Mailing Address - City:CATONSVILLE
Mailing Address - State:MD
Mailing Address - Zip Code:21228-4147
Mailing Address - Country:US
Mailing Address - Phone:410-247-7500
Mailing Address - Fax:410-737-6884
Practice Address - Street 1:700 GEIPE RD
Practice Address - Street 2:SUITE 230
Practice Address - City:CATONSVILLE
Practice Address - State:MD
Practice Address - Zip Code:21228-4147
Practice Address - Country:US
Practice Address - Phone:410-247-7500
Practice Address - Fax:410-737-6884
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:DIGESTIVE DISEASE ASSOCIATES, P.A.
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2006-08-09
Last Update Date:2015-04-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MD207L00000X, 207RG0100X, 207ZP0102X, 367500000X
207RI0008X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207RG0100XAllopathic & Osteopathic PhysiciansInternal MedicineGastroenterologyGroup - Multi-Specialty
No207L00000XAllopathic & Osteopathic PhysiciansAnesthesiologyGroup - Multi-Specialty
No207RI0008XAllopathic & Osteopathic PhysiciansInternal MedicineHepatologyGroup - Multi-Specialty
No207ZP0102XAllopathic & Osteopathic PhysiciansPathologyAnatomic Pathology & Clinical PathologyGroup - Multi-Specialty
No367500000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Anesthetist, Certified RegisteredGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
MD051921900Medicaid
MD051921900Medicaid