Provider Demographics
NPI:1760413918
Name:WILSON DIGESTIVE DISEASES CENTER PA
Entity Type:Organization
Organization Name:WILSON DIGESTIVE DISEASES CENTER PA
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:DUANE
Authorized Official - Middle Name:DOUGLAS
Authorized Official - Last Name:FITCH
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:252-237-4100
Mailing Address - Street 1:2402 CAMDEN ST
Mailing Address - Street 2:STE 300
Mailing Address - City:WILSON
Mailing Address - State:NC
Mailing Address - Zip Code:27893
Mailing Address - Country:US
Mailing Address - Phone:252-237-4100
Mailing Address - Fax:252-237-8449
Practice Address - Street 1:2402 CAMDEN ST
Practice Address - Street 2:STE 300
Practice Address - City:WILSON
Practice Address - State:NC
Practice Address - Zip Code:27893
Practice Address - Country:US
Practice Address - Phone:252-237-4100
Practice Address - Fax:252-237-8449
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-07-05
Last Update Date:2014-01-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207RG0100XAllopathic & Osteopathic PhysiciansInternal MedicineGastroenterologyGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
NC0202FOtherBLUE CROSS BLUE SHIELD OF
NC890202FMedicaid
NC890202FMedicaid
NC206312BMedicare ID - Type Unspecified