Provider Demographics
NPI:1811211394
Name:DIGESTIVE DISEASE CENTER OF VIRGINIA, PC
Entity Type:Organization
Organization Name:DIGESTIVE DISEASE CENTER OF VIRGINIA, PC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PHYSICIAN
Authorized Official - Prefix:
Authorized Official - First Name:RICHARD
Authorized Official - Middle Name:J
Authorized Official - Last Name:HARTLE
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:757-232-8769
Mailing Address - Street 1:5424 DISCOVERY PARK BLVD
Mailing Address - Street 2:SUITE 203
Mailing Address - City:WILLIAMSBURG
Mailing Address - State:VA
Mailing Address - Zip Code:23188-2862
Mailing Address - Country:US
Mailing Address - Phone:757-232-8769
Mailing Address - Fax:757-232-8875
Practice Address - Street 1:4125 IRONBOUND RD
Practice Address - Street 2:SUITE 201
Practice Address - City:WILLIAMSBURG
Practice Address - State:VA
Practice Address - Zip Code:23188-2666
Practice Address - Country:US
Practice Address - Phone:757-232-8769
Practice Address - Fax:757-232-8875
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2010-03-26
Last Update Date:2011-08-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA0101049148207RG0100X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207RG0100XAllopathic & Osteopathic PhysiciansInternal MedicineGastroenterologyGroup - Single Specialty