Provider Demographics
NPI:1659388296
Name:ROCKFORD DIGESTIVE HEALTH SPECIALISTS, P.A.
Entity Type:Organization
Organization Name:ROCKFORD DIGESTIVE HEALTH SPECIALISTS, P.A.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:MD
Authorized Official - Prefix:DR
Authorized Official - First Name:GLENN
Authorized Official - Middle Name:
Authorized Official - Last Name:PFITZNER
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:336-719-7993
Mailing Address - Street 1:951 ROCKFORD ST
Mailing Address - Street 2:
Mailing Address - City:MOUNT AIRY
Mailing Address - State:NC
Mailing Address - Zip Code:27030-5323
Mailing Address - Country:US
Mailing Address - Phone:336-719-7993
Mailing Address - Fax:336-719-6550
Practice Address - Street 1:951 ROCKFORD ST
Practice Address - Street 2:
Practice Address - City:MOUNT AIRY
Practice Address - State:NC
Practice Address - Zip Code:27030-5323
Practice Address - Country:US
Practice Address - Phone:336-719-7993
Practice Address - Fax:336-719-6550
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-08-02
Last Update Date:2012-01-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC9501055207RG0100X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207RG0100XAllopathic & Osteopathic PhysiciansInternal MedicineGastroenterologyGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
NC78894OtherCORPORATE CERTIFICATE
NC78894OtherCORPORATE CERTIFICATE
NCE90949Medicare UPIN