Provider Demographics
NPI:1801044318
Name:WILSON DIGESTIVE DISEASES CENTER PA
Entity Type:Organization
Organization Name:WILSON DIGESTIVE DISEASES CENTER PA
Other - Org Name:WILSON DIGESTIVE DISEASES ENDOSCOPY CENTER
Other - Org Type:Doing Business As
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:252-237-5060
Mailing Address - Street 1:2402 CAMDEN STREET
Mailing Address - Street 2:SUITE 200
Mailing Address - City:WILSON
Mailing Address - State:NC
Mailing Address - Zip Code:27893
Mailing Address - Country:US
Mailing Address - Phone:252-237-5060
Mailing Address - Fax:252-237-8449
Practice Address - Street 1:2402 CAMDEN STREET
Practice Address - Street 2:SUITE 200
Practice Address - City:WILSON
Practice Address - State:NC
Practice Address - Zip Code:27893
Practice Address - Country:US
Practice Address - Phone:252-237-5060
Practice Address - Fax:252-237-8449
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:WILSON DIGESTIVE DISEASES CENTER PA
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2008-09-09
Last Update Date:2008-09-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC25997207RG0100X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207RG0100XAllopathic & Osteopathic PhysiciansInternal MedicineGastroenterologyGroup - Single Specialty