Provider Demographics
NPI:1376790238
Name:DIGESTIVE CARE, LLC
Entity Type:Organization
Organization Name:DIGESTIVE CARE, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:PRATHIBHA
Authorized Official - Middle Name:
Authorized Official - Last Name:CHANDRASEKARAN
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:831-728-1410
Mailing Address - Street 1:243 GREEN VALLEY RD
Mailing Address - Street 2:SUITE E
Mailing Address - City:FREEDOM
Mailing Address - State:CA
Mailing Address - Zip Code:95019-3133
Mailing Address - Country:US
Mailing Address - Phone:831-728-1410
Mailing Address - Fax:831-728-2076
Practice Address - Street 1:243 GREEN VALLEY RD
Practice Address - Street 2:SUITE E
Practice Address - City:FREEDOM
Practice Address - State:CA
Practice Address - Zip Code:95019-3133
Practice Address - Country:US
Practice Address - Phone:831-728-1410
Practice Address - Fax:831-728-2076
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2008-08-22
Last Update Date:2013-05-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAC55292207RG0100X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207RG0100XAllopathic & Osteopathic PhysiciansInternal MedicineGastroenterologyGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
NJ8607001Medicaid
NJ8607001Medicaid