Provider Demographics
NPI:1841226016
Name:RAPPAHANNOCK GASTROENTEROLOGY ASSOCIATES, PLC
Entity Type:Organization
Organization Name:RAPPAHANNOCK GASTROENTEROLOGY ASSOCIATES, PLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRACTICE MANAGER
Authorized Official - Prefix:
Authorized Official - First Name:SUE
Authorized Official - Middle Name:
Authorized Official - Last Name:TRIBLE
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:540-370-0430
Mailing Address - Street 1:1500 DIXON ST
Mailing Address - Street 2:#202
Mailing Address - City:FREDERICKSBURG
Mailing Address - State:VA
Mailing Address - Zip Code:22401
Mailing Address - Country:US
Mailing Address - Phone:540-370-0430
Mailing Address - Fax:540-370-0021
Practice Address - Street 1:1500 DIXON ST
Practice Address - Street 2:#202
Practice Address - City:FREDERICKSBURG
Practice Address - State:VA
Practice Address - Zip Code:22401
Practice Address - Country:US
Practice Address - Phone:540-370-0430
Practice Address - Fax:540-370-0021
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-06-22
Last Update Date:2012-02-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207RG0100XAllopathic & Osteopathic PhysiciansInternal MedicineGastroenterologyGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
VAC09093Medicare PIN