Provider Demographics
NPI:1801826177
Name:PHILADELPHIA GASTROENTEROLOGY GROUP, P.C.
Entity Type:Organization
Organization Name:PHILADELPHIA GASTROENTEROLOGY GROUP, P.C.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OFFICE MANAGER
Authorized Official - Prefix:
Authorized Official - First Name:ANNAMARIE
Authorized Official - Middle Name:
Authorized Official - Last Name:ANDREWS
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:215-463-1483
Mailing Address - Street 1:525 JAMESTOWN ST
Mailing Address - Street 2:SUITE 101
Mailing Address - City:PHILADELPHIA
Mailing Address - State:PA
Mailing Address - Zip Code:19128-1751
Mailing Address - Country:US
Mailing Address - Phone:215-463-1483
Mailing Address - Fax:215-483-9185
Practice Address - Street 1:525 JAMESTOWN ST
Practice Address - Street 2:SUITE 101
Practice Address - City:PHILADELPHIA
Practice Address - State:PA
Practice Address - Zip Code:19128-1751
Practice Address - Country:US
Practice Address - Phone:215-463-1483
Practice Address - Fax:215-483-9185
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-07-03
Last Update Date:2017-02-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207RG0100XAllopathic & Osteopathic PhysiciansInternal MedicineGastroenterologyGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
PA000893827-0001Medicaid
NJ0055417Medicaid
NJ0055417Medicaid
NJCE9879Medicare PIN
PACF7072Medicare PIN
PA073969Medicare PIN