Provider Demographics
NPI:1437245859
Name:PENINSULA GASTROENTEROLOGY ASSN , P A
Entity Type:Organization
Organization Name:PENINSULA GASTROENTEROLOGY ASSN , P A
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:KOTA
Authorized Official - Middle Name:
Authorized Official - Last Name:CHANDRASEKHARA
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:410-896-3693
Mailing Address - Street 1:PO BOX 157
Mailing Address - Street 2:
Mailing Address - City:DELMAR
Mailing Address - State:DE
Mailing Address - Zip Code:19940-0157
Mailing Address - Country:US
Mailing Address - Phone:410-896-3693
Mailing Address - Fax:410-896-3698
Practice Address - Street 1:9315 OCEAN HWY
Practice Address - Street 2:SUITE B
Practice Address - City:DELMAR
Practice Address - State:MD
Practice Address - Zip Code:21875-2339
Practice Address - Country:US
Practice Address - Phone:410-896-3693
Practice Address - Fax:410-896-3698
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-10-04
Last Update Date:2009-05-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207RG0100XAllopathic & Osteopathic PhysiciansInternal MedicineGastroenterologyGroup - Single Specialty