Provider Demographics
NPI:1104874064
Name:EASTERN PENNSYLVANIA GASTROENTEROLOGY & LIVER SPECIALISTS P C
Entity type:Organization
Organization Name:EASTERN PENNSYLVANIA GASTROENTEROLOGY & LIVER SPECIALISTS P C
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PHYSICIAN
Authorized Official - Prefix:DR
Authorized Official - First Name:ANTHONY
Authorized Official - Middle Name:G
Authorized Official - Last Name:AUTERI
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:610-821-2828
Mailing Address - Street 1:1501 N CEDAR CREST BLVD STE 110
Mailing Address - Street 2:
Mailing Address - City:ALLENTOWN
Mailing Address - State:PA
Mailing Address - Zip Code:18104-2309
Mailing Address - Country:US
Mailing Address - Phone:610-821-2828
Mailing Address - Fax:610-821-7915
Practice Address - Street 1:1501 N CEDAR CREST BLVD STE 110
Practice Address - Street 2:
Practice Address - City:ALLENTOWN
Practice Address - State:PA
Practice Address - Zip Code:18104-2309
Practice Address - Country:US
Practice Address - Phone:610-821-2828
Practice Address - Fax:610-821-7915
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-05-04
Last Update Date:2024-12-31
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207RG0100XAllopathic & Osteopathic PhysiciansInternal MedicineGastroenterologyGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
PA0009936080007Medicaid
PA062152Medicare ID - Type Unspecified