Provider Demographics
NPI:1205814084
Name:APPALACHIAN GASTROENTEROLOGY PA
Entity Type:Organization
Organization Name:APPALACHIAN GASTROENTEROLOGY PA
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:DOUGLAS
Authorized Official - Middle Name:
Authorized Official - Last Name:TRATE
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:828-264-0029
Mailing Address - Street 1:870 STATE FARM RD
Mailing Address - Street 2:SUITE 102
Mailing Address - City:BOONE
Mailing Address - State:NC
Mailing Address - Zip Code:28607-4861
Mailing Address - Country:US
Mailing Address - Phone:828-264-0029
Mailing Address - Fax:828-265-3305
Practice Address - Street 1:870 STATE FARM RD
Practice Address - Street 2:SUITE 102
Practice Address - City:BOONE
Practice Address - State:NC
Practice Address - Zip Code:28607-4861
Practice Address - Country:US
Practice Address - Phone:828-264-0029
Practice Address - Fax:828-265-3305
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-01-03
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC9600754207RG0100X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207RG0100XAllopathic & Osteopathic PhysiciansInternal MedicineGastroenterologyGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
NC8901472Medicaid
NC8901472Medicaid