Provider Demographics
NPI:1467572826
Name:CAMBRIA GASTROENTEROLOGY, INC.
Entity Type:Organization
Organization Name:CAMBRIA GASTROENTEROLOGY, INC.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:HIRA
Authorized Official - Middle Name:L
Authorized Official - Last Name:KOUL
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:814-525-1500
Mailing Address - Street 1:970 FRANKLIN ST
Mailing Address - Street 2:
Mailing Address - City:JOHNSTOWN
Mailing Address - State:PA
Mailing Address - Zip Code:15905-4107
Mailing Address - Country:US
Mailing Address - Phone:814-535-1500
Mailing Address - Fax:814-536-5648
Practice Address - Street 1:970 FRANKLIN ST
Practice Address - Street 2:
Practice Address - City:JOHNSTOWN
Practice Address - State:PA
Practice Address - Zip Code:15905-4107
Practice Address - Country:US
Practice Address - Phone:814-535-1500
Practice Address - Fax:814-536-5648
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-03-30
Last Update Date:2009-03-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PAMD037398L207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal MedicineGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
PA0007478920001Medicaid
PA0007478920001Medicaid
PA153837E2EMedicare ID - Type Unspecified