Provider Demographics
NPI:1598047508
Name:PRESQUE ISLE COLON AND RECTAL SURGERY
Entity Type:Organization
Organization Name:PRESQUE ISLE COLON AND RECTAL SURGERY
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PROVIDER
Authorized Official - Prefix:DR
Authorized Official - First Name:BRIAN
Authorized Official - Middle Name:J
Authorized Official - Last Name:BANSIDHAR
Authorized Official - Suffix:
Authorized Official - Credentials:DO
Authorized Official - Phone:814-833-1119
Mailing Address - Street 1:4125 W RIDGE RD
Mailing Address - Street 2:
Mailing Address - City:ERIE
Mailing Address - State:PA
Mailing Address - Zip Code:16506-1763
Mailing Address - Country:US
Mailing Address - Phone:814-833-1119
Mailing Address - Fax:814-833-1138
Practice Address - Street 1:4125 W RIDGE RD
Practice Address - Street 2:
Practice Address - City:ERIE
Practice Address - State:PA
Practice Address - Zip Code:16506-1763
Practice Address - Country:US
Practice Address - Phone:814-833-1119
Practice Address - Fax:814-833-1138
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2011-09-15
Last Update Date:2016-04-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes208C00000XAllopathic & Osteopathic PhysiciansColon & Rectal SurgeryGroup - Single Specialty