1104934942 NPI number — GASTROENTEROLOGY ASSOCIATES, PEAR M. ENAM, M.D., PA

Table of content: (NPI 1104934942)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1104934942 NPI number — GASTROENTEROLOGY ASSOCIATES, PEAR M. ENAM, M.D., PA

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
GASTROENTEROLOGY ASSOCIATES, PEAR M. ENAM, M.D., PA
Provider Last Name:
Provider First Name:
Provider Middle Name:
Provider Name Prefix Text:
Provider Name Suffix Text:
Provider Credential Text:
Provider Gender Code:

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
Provider Other Last Name:
Provider Other First Name:
Provider Other Middle Name:
Provider Other Name Prefix Text:
Provider Other Name Suffix Text:
Provider Other Credential Text:
Provider Other Last Name Type Code:

NPI Number Information

NPI Number:
1104934942
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
08/24/2022
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
11110 MEDICAL CAMPUS RD
Provider Second Line Business Mailing Address:
SUITE 250
Provider Business Mailing Address City Name:
HAGERSTOWN
Provider Business Mailing Address State Name:
MD
Provider Business Mailing Address Postal Code:
21742-6700
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
301-733-4404
Provider Business Mailing Address Fax Number:
301-733-3984

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
11110 MEDICAL CAMPUS RD
Provider Second Line Business Practice Location Address:
SUITE 250
Provider Business Practice Location Address City Name:
HAGERSTOWN
Provider Business Practice Location Address State Name:
MD
Provider Business Practice Location Address Postal Code:
21742-6700
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
301-733-4404
Provider Business Practice Location Address Fax Number:
301-733-3984
Provider Enumeration Date:
08/29/2006

Additional Information

Authorized Official

Authorized Official Last Name:
BLIZZARD
Authorized Official First Name:
STACEY
Authorized Official Middle Name:
Authorized Official Title or Position:
OFFICE MANAGER
Authorized Official Telephone Number:
301-733-4404

Provider Taxonomy Codes

  • Taxonomy code: 174400000X ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

Other Provider's Identifiers (legacy, non-NPI)

  • Identifier: 2003711 . This is a "AETNA - HMO - GOUP" identifier . This identifiers is of the category "OTHER".
  • Identifier: 4400511 . This is a "AETNA - PPO - ENAM" identifier . This identifiers is of the category "OTHER".
  • Identifier: 1538148283 . This is a "INDIVIDUAL NPI - CHOUDARI" identifier . This identifiers is of the category "OTHER".
  • Identifier: 526933-02 . This is a "CAREFIRST - ENAM" identifier . This identifiers is of the category "OTHER".
  • Identifier: 1780687616 . This is a "NPI INDIVIDUAL - ENAM" identifier . This identifiers is of the category "OTHER".
  • Identifier: 265001100 , issued by the state of ( MD ) . This identifiers is of the category "MEDICAID".
  • Identifier: 5476652 . This is a "AETNA - PPO - HANIF" identifier . This identifiers is of the category "OTHER".
  • Identifier: 5531514 . This is a "AETNA - PPO - GROUP" identifier . This identifiers is of the category "OTHER".
  • Identifier: 2010644 . This is a "AETNA - HANIF" identifier . This identifiers is of the category "OTHER".
  • Identifier: 1285637116 . This is a "NPI INDIVIDUAL - HANIF" identifier . This identifiers is of the category "OTHER".
  • Identifier: 515001900 , issued by the state of ( MD ) . This identifiers is of the category "MEDICAID".
  • Identifier: 606031500 , issued by the state of ( MD ) . This identifiers is of the category "MEDICAID".
  • Identifier: 2123375 . This is a "ALLIANCE - ENAM" identifier . This identifiers is of the category "OTHER".
  • Identifier: 2123380 . This is a "ALLIANCE - HANIF" identifier . This identifiers is of the category "OTHER".
  • Identifier: 614460-02 . This is a "CAREFIRST - HANIF" identifier . This identifiers is of the category "OTHER".
  • Identifier: 533100 . This is a "AETNA - ENAM" identifier . This identifiers is of the category "OTHER".




Copyright © 2007-2024 www.npivalidator.com