Provider Demographics
NPI:1578748232
Name:DELCO GASTROENTEROLOGY
Entity Type:Organization
Organization Name:DELCO GASTROENTEROLOGY
Other - Org Name:ENDOSCOPY CENTER OF DELAWARE
Other - Org Type:Doing Business As
Authorized Official - Title/Position:DIRECTOR
Authorized Official - Prefix:
Authorized Official - First Name:PSCAR
Authorized Official - Middle Name:
Authorized Official - Last Name:LABORDA
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:610-565-1808
Mailing Address - Street 1:1088 WEST BALTIMORE PIKE
Mailing Address - Street 2:SUITE 2407
Mailing Address - City:MEDIA
Mailing Address - State:PA
Mailing Address - Zip Code:19063-5146
Mailing Address - Country:US
Mailing Address - Phone:610-565-1808
Mailing Address - Fax:610-892-9535
Practice Address - Street 1:1088 WEST BALTIMORE PIKE
Practice Address - Street 2:SUITE 2407
Practice Address - City:MEDIA
Practice Address - State:PA
Practice Address - Zip Code:19063-5146
Practice Address - Country:US
Practice Address - Phone:610-565-1808
Practice Address - Fax:610-892-9535
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-12-31
Last Update Date:2009-10-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PA16001501261QA1903X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QA1903XAmbulatory Health Care FacilitiesClinic/CenterAmbulatory Surgical
Provider Identifiers
StateIdentifier IDID TypeIssuer
PA066876Medicare PIN