Provider Demographics
NPI:1982758603
Name:MORRISTOWN GASTROENTEROLOGY, P.C
Entity Type:Organization
Organization Name:MORRISTOWN GASTROENTEROLOGY, P.C
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:SIVA
Authorized Official - Middle Name:
Authorized Official - Last Name:MARAN
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:423-587-0860
Mailing Address - Street 1:705 N HIGH ST
Mailing Address - Street 2:SUITE A
Mailing Address - City:MORRISTOWN
Mailing Address - State:TN
Mailing Address - Zip Code:37814-3876
Mailing Address - Country:US
Mailing Address - Phone:423-587-0860
Mailing Address - Fax:423-586-1027
Practice Address - Street 1:705 N HIGH ST
Practice Address - Street 2:SUITE A
Practice Address - City:MORRISTOWN
Practice Address - State:TN
Practice Address - Zip Code:37814-3876
Practice Address - Country:US
Practice Address - Phone:423-587-0860
Practice Address - Fax:423-586-1027
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-01-22
Last Update Date:2013-04-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207RG0100XAllopathic & Osteopathic PhysiciansInternal MedicineGastroenterologyGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
TN3719779Medicaid
TN3719779Medicaid