Provider Demographics
NPI:1295819084
Name:REGIONAL GASTROENTEROLOGY ASSOCIATES OF LANCASTER, LTD.
Entity Type:Organization
Organization Name:REGIONAL GASTROENTEROLOGY ASSOCIATES OF LANCASTER, LTD.
Other - Org Name:MID-ATLANTIC GASTROINTESTINAL CENTER
Other - Org Type:Doing Business As
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:DALE
Authorized Official - Middle Name:
Authorized Official - Last Name:WHITEBLOOM
Authorized Official - Suffix:
Authorized Official - Credentials:DO
Authorized Official - Phone:717-544-3400
Mailing Address - Street 1:2104 HARRISBURG PIKE STE. 300
Mailing Address - Street 2:PO BOX 3200
Mailing Address - City:LANCASTER
Mailing Address - State:PA
Mailing Address - Zip Code:17604-3200
Mailing Address - Country:US
Mailing Address - Phone:717-544-3400
Mailing Address - Fax:717-544-3408
Practice Address - Street 1:2104 HARRISBURG PIKE STE 300
Practice Address - Street 2:
Practice Address - City:LANCASTER
Practice Address - State:PA
Practice Address - Zip Code:17601-2644
Practice Address - Country:US
Practice Address - Phone:717-544-3400
Practice Address - Fax:717-544-3408
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:REGIONAL GASTROENTEROLOGY ASSOCIATES OF LANCASTER, LTD
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2006-10-25
Last Update Date:2012-06-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PA15891501261QA1903X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QA1903XAmbulatory Health Care FacilitiesClinic/CenterAmbulatory Surgical
Provider Identifiers
StateIdentifier IDID TypeIssuer
PA059345Medicare PIN