Provider Demographics
NPI:1558696559
Name:EASTERN SHORE GASTROENTEROLOGY, P.C.
Entity Type:Organization
Organization Name:EASTERN SHORE GASTROENTEROLOGY, P.C.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:STEPHEN
Authorized Official - Middle Name:L
Authorized Official - Last Name:COLEMAN
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:251-753-6462
Mailing Address - Street 1:188 HOSPITAL DR
Mailing Address - Street 2:405
Mailing Address - City:FAIRHOPE
Mailing Address - State:AL
Mailing Address - Zip Code:36532-2043
Mailing Address - Country:US
Mailing Address - Phone:251-753-6462
Mailing Address - Fax:251-279-4601
Practice Address - Street 1:188 HOSPITAL DR
Practice Address - Street 2:405
Practice Address - City:FAIRHOPE
Practice Address - State:AL
Practice Address - Zip Code:36532-2043
Practice Address - Country:US
Practice Address - Phone:251-753-6462
Practice Address - Fax:251-279-4601
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2009-10-08
Last Update Date:2020-01-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AL8781207RG0100X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207RG0100XAllopathic & Osteopathic PhysiciansInternal MedicineGastroenterologyGroup - Single Specialty