Provider Demographics
NPI:1285030080
Name:GREATER MONTGOMERY PATIENT CENTERED GASTROENTEROLOGY AND HEPATOLOGY
Entity Type:Organization
Organization Name:GREATER MONTGOMERY PATIENT CENTERED GASTROENTEROLOGY AND HEPATOLOGY
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CEO
Authorized Official - Prefix:DR
Authorized Official - First Name:VIPLOVE
Authorized Official - Middle Name:
Authorized Official - Last Name:SENADHI
Authorized Official - Suffix:
Authorized Official - Credentials:DO
Authorized Official - Phone:215-740-0034
Mailing Address - Street 1:1898 MULBERRY ST
Mailing Address - Street 2:
Mailing Address - City:MONTGOMERY
Mailing Address - State:AL
Mailing Address - Zip Code:36106-1526
Mailing Address - Country:US
Mailing Address - Phone:334-239-7059
Mailing Address - Fax:334-239-7841
Practice Address - Street 1:1722 PINE ST
Practice Address - Street 2:SUITE 801
Practice Address - City:MONTGOMERY
Practice Address - State:AL
Practice Address - Zip Code:36106-1103
Practice Address - Country:US
Practice Address - Phone:334-293-8000
Practice Address - Fax:334-532-0108
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2014-11-06
Last Update Date:2019-07-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
207RG0100X
ALDO.1453207RI0008X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207RG0100XAllopathic & Osteopathic PhysiciansInternal MedicineGastroenterologyGroup - Multi-Specialty
No207RI0008XAllopathic & Osteopathic PhysiciansInternal MedicineHepatologyGroup - Multi-Specialty