Provider Demographics
NPI:1245258466
Name:ANNE ARUNDEL GASTROENTEROLOGY ASSOCIATES PA
Entity type:Organization
Organization Name:ANNE ARUNDEL GASTROENTEROLOGY ASSOCIATES PA
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:EXECUTIVE DIRECTOR
Authorized Official - Prefix:
Authorized Official - First Name:BRENDA
Authorized Official - Middle Name:MARSHA
Authorized Official - Last Name:BOSMA
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:443-837-2011
Mailing Address - Street 1:820 BESTGATE RD
Mailing Address - Street 2:SUITE 2B
Mailing Address - City:ANNAPOLIS
Mailing Address - State:MD
Mailing Address - Zip Code:21401-3404
Mailing Address - Country:US
Mailing Address - Phone:410-224-2116
Mailing Address - Fax:410-224-2118
Practice Address - Street 1:820 BESTGATE RD
Practice Address - Street 2:SUITE 2A
Practice Address - City:ANNAPOLIS
Practice Address - State:MD
Practice Address - Zip Code:21401-3404
Practice Address - Country:US
Practice Address - Phone:410-224-2116
Practice Address - Fax:410-224-2118
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-07-17
Last Update Date:2012-11-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes174400000XOther Service ProvidersSpecialistGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
MD438601900Medicaid
MD438601900Medicaid
H425Medicare PIN
DC181928Medicare PIN