Provider Demographics
NPI:1982676318
Name:ADVANCED GASTROENTEROLOGY ASSOCIATES PC
Entity Type:Organization
Organization Name:ADVANCED GASTROENTEROLOGY ASSOCIATES PC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:RAVI
Authorized Official - Middle Name:
Authorized Official - Last Name:REDDY
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:704-982-9800
Mailing Address - Street 1:929 NORTH SECOND STREET
Mailing Address - Street 2:SUITE 105
Mailing Address - City:ALBEMARLE
Mailing Address - State:NC
Mailing Address - Zip Code:28001
Mailing Address - Country:US
Mailing Address - Phone:704-982-9800
Mailing Address - Fax:704-982-5112
Practice Address - Street 1:929 NORTH SECOND STREET
Practice Address - Street 2:SUITE 105
Practice Address - City:ALBEMARLE
Practice Address - State:NC
Practice Address - Zip Code:28001
Practice Address - Country:US
Practice Address - Phone:704-982-9800
Practice Address - Fax:704-982-5112
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-02-01
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207RG0100XAllopathic & Osteopathic PhysiciansInternal MedicineGastroenterologyGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
NC89137F3Medicaid
NC2338600Medicare ID - Type Unspecified