Provider Demographics
NPI:1477668390
Name:CROWN GASTROENTEROLOGY ASSOCIATES
Entity Type:Organization
Organization Name:CROWN GASTROENTEROLOGY ASSOCIATES
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:WILLIAM
Authorized Official - Middle Name:
Authorized Official - Last Name:SILBER
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:207-764-0679
Mailing Address - Street 1:11 MARTIN ST
Mailing Address - Street 2:
Mailing Address - City:PRESQUE ISLE
Mailing Address - State:ME
Mailing Address - Zip Code:04769-2238
Mailing Address - Country:US
Mailing Address - Phone:207-764-0679
Mailing Address - Fax:207-764-1569
Practice Address - Street 1:11 MARTIN ST
Practice Address - Street 2:
Practice Address - City:PRESQUE ISLE
Practice Address - State:ME
Practice Address - Zip Code:04769-2238
Practice Address - Country:US
Practice Address - Phone:207-764-0679
Practice Address - Fax:207-764-1569
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-08-20
Last Update Date:2009-06-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207RG0100XAllopathic & Osteopathic PhysiciansInternal MedicineGastroenterologyGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
ME007258OtherANTHEM
ME100009202OtherRAILROAD MEDICARE
ME1041858OtherAETNA
ME125140000MEMedicaid
ME2204280OtherCIGNA
ME125140000MEMedicaid