Provider Demographics
NPI:1164541686
Name:DIGESTIVE HEALTH SPECIALISTS OF EASTERN CONNECTICUT LLC
Entity Type:Organization
Organization Name:DIGESTIVE HEALTH SPECIALISTS OF EASTERN CONNECTICUT LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PHYSICIAN PARTNER
Authorized Official - Prefix:
Authorized Official - First Name:PETER
Authorized Official - Middle Name:S
Authorized Official - Last Name:BUCH
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:860-649-3477
Mailing Address - Street 1:353 MAIN ST
Mailing Address - Street 2:
Mailing Address - City:MANCHESTER
Mailing Address - State:CT
Mailing Address - Zip Code:06040-4145
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:353 MAIN ST
Practice Address - Street 2:
Practice Address - City:MANCHESTER
Practice Address - State:CT
Practice Address - Zip Code:06040-4145
Practice Address - Country:US
Practice Address - Phone:860-649-3477
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-03-28
Last Update Date:2012-06-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207RG0100XAllopathic & Osteopathic PhysiciansInternal MedicineGastroenterologyGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
CTB38999Medicare UPIN
CTG24158Medicare UPIN
CT100000075Medicare ID - Type UnspecifiedPETER S BUCH, MD
CT110006160Medicare ID - Type UnspecifiedJAMES W O'BRIEN, MD