Provider Demographics
NPI:1417092297
Name:TRISTATE COLON AND RECTAL ASSOCIATES PC
Entity Type:Organization
Organization Name:TRISTATE COLON AND RECTAL ASSOCIATES PC
Other - Org Name:STEPHEN C. SILVER MD ASSOCIATES
Other - Org Type:Former Legal Business Name
Authorized Official - Title/Position:PRESIDENT/OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:TARO
Authorized Official - Middle Name:
Authorized Official - Last Name:ARAI
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:610-446-7882
Mailing Address - Street 1:1010 WEST CHESTER PIKE
Mailing Address - Street 2:SUITE 201
Mailing Address - City:HAVERTOWN
Mailing Address - State:PA
Mailing Address - Zip Code:19083-3442
Mailing Address - Country:US
Mailing Address - Phone:610-466-7882
Mailing Address - Fax:610-446-3316
Practice Address - Street 1:1010 WEST CHESTER PIKE
Practice Address - Street 2:SUITE 201
Practice Address - City:HAVERTOWN
Practice Address - State:PA
Practice Address - Zip Code:19083-3442
Practice Address - Country:US
Practice Address - Phone:610-466-7882
Practice Address - Fax:610-446-3316
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-02-20
Last Update Date:2016-02-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes208C00000XAllopathic & Osteopathic PhysiciansColon & Rectal SurgeryGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
PA01669001Medicaid
0142807000OtherKEYSTONE HEALTH PLAN EAST
889853OtherPA BLUE SHIELD
0142807000OtherKEYSTONE HEALTH PLAN EAST