Provider Demographics
NPI:1912903287
Name:DIGESTIVE CARE CONSULTANTS PC
Entity Type:Organization
Organization Name:DIGESTIVE CARE CONSULTANTS PC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:BALU
Authorized Official - Middle Name:
Authorized Official - Last Name:SHETTY
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:724-864-0503
Mailing Address - Street 1:585 RUGH STREET
Mailing Address - Street 2:SUITE 202
Mailing Address - City:GREENSBURG
Mailing Address - State:PA
Mailing Address - Zip Code:15601-5667
Mailing Address - Country:US
Mailing Address - Phone:724-838-1534
Mailing Address - Fax:724-838-1536
Practice Address - Street 1:8775 NORWIN AVENUE
Practice Address - Street 2:
Practice Address - City:NORTH HUNTINGDON
Practice Address - State:PA
Practice Address - Zip Code:15642-2718
Practice Address - Country:US
Practice Address - Phone:724-864-0503
Practice Address - Fax:724-864-0535
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2005-06-22
Last Update Date:2011-11-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PA077567207RG0100X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207RG0100XAllopathic & Osteopathic PhysiciansInternal MedicineGastroenterologyGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
PA200938995 0002Medicaid
DB3734OtherRR MEDICARE
DB3734OtherRR MEDICARE