Provider Demographics
NPI:1013246727
Name:DIGESTIVE DISEASE CENTER, PA
Entity Type:Organization
Organization Name:DIGESTIVE DISEASE CENTER, PA
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:MEDICAL DIRECTOR
Authorized Official - Prefix:DR
Authorized Official - First Name:VENKATA
Authorized Official - Middle Name:C
Authorized Official - Last Name:MOTAPARTHY
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:919-731-2126
Mailing Address - Street 1:2705 MEDICAL OFFICE PL
Mailing Address - Street 2:
Mailing Address - City:GOLDSBORO
Mailing Address - State:NC
Mailing Address - Zip Code:27534-9458
Mailing Address - Country:US
Mailing Address - Phone:919-731-2526
Mailing Address - Fax:919-580-0988
Practice Address - Street 1:2705 MEDICAL OFFICE PL
Practice Address - Street 2:
Practice Address - City:GOLDSBORO
Practice Address - State:NC
Practice Address - Zip Code:27534-9458
Practice Address - Country:US
Practice Address - Phone:919-731-2526
Practice Address - Fax:919-580-0988
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2009-12-09
Last Update Date:2009-12-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC25379207RG0100X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207RG0100XAllopathic & Osteopathic PhysiciansInternal MedicineGastroenterologyGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
NC873282Medicaid
NC873282Medicaid
NC202918Medicare PIN