Provider Demographics
NPI:1346242237
Name:GASTROINTESTINAL DISEASE CENTER PA
Entity Type:Organization
Organization Name:GASTROINTESTINAL DISEASE CENTER PA
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:DOCTOR
Authorized Official - Prefix:DR
Authorized Official - First Name:DENNIS
Authorized Official - Middle Name:M
Authorized Official - Last Name:TOLAND
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:281-955-0262
Mailing Address - Street 1:11301 FALLBROOK DR
Mailing Address - Street 2:SUITE 214
Mailing Address - City:HOUSTON
Mailing Address - State:TX
Mailing Address - Zip Code:77065-4237
Mailing Address - Country:US
Mailing Address - Phone:281-955-0262
Mailing Address - Fax:832-237-1905
Practice Address - Street 1:11301 FALLBROOK DR
Practice Address - Street 2:SUITE 214
Practice Address - City:HOUSTON
Practice Address - State:TX
Practice Address - Zip Code:77065-4237
Practice Address - Country:US
Practice Address - Phone:281-955-0262
Practice Address - Fax:832-237-1905
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2005-08-11
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TXE1156207RG0100X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207RG0100XAllopathic & Osteopathic PhysiciansInternal MedicineGastroenterologyGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX00369RMedicare ID - Type Unspecified