| Digestive Disease Associates, Llc | |
|
1224 Main St Branford CT 06405-3778 | |
| (203) 481-0315 | |
| (203) 481-6788 |
| Full Name | Digestive Disease Associates, Llc |
|---|---|
| Speciality | Internal Medicine |
| Location | 1224 Main St, Branford, Connecticut |
| Authorized Official Name and Position | Christopher Dunbar Illick (PARTNER) |
| Authorized Official Contact | 2034810315 |
| Accepts Medicare Insurance | Yes. This clinic participates in medicare program and accept medicare insurance. |
| Mailing Address | Practice Location Address |
|---|---|
| Digestive Disease Associates, Llc 687 Main St Branford CT 06405-3612 Ph: (203) 481-7050 | Digestive Disease Associates, Llc 1224 Main St Branford CT 06405-3778 Ph: (203) 481-0315 |
| NPI Number | 1356480578 |
|---|---|
| Provider Enumeration Date | 02/05/2007 |
| Last Update Date | 01/12/2024 |
| Medicare PECOS PAC ID | 5395644512 |
|---|---|
| Medicare Enrollment ID | O20040107000567 |
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1356480578 | NPI | - | NPPES |
| 004070314 | Medicaid | CT |
| Taxonomy | Type | License (State) | Status |
|---|---|---|---|
| 207RG0100X | Internal Medicine - Gastroenterology | (* (Not Available)) | Primary |
| Provider Name | Christopher Illick |
|---|---|
| Provider Type | Practitioner - Gastroenterology |
| Provider Identifiers | NPI Number: 1609836998 PECOS PAC ID: 6406884279 Enrollment ID: I20050802000896 |
| Provider Name | Frank A Bauer |
|---|---|
| Provider Type | Practitioner - Pathology |
| Provider Identifiers | NPI Number: 1851416739 PECOS PAC ID: 3779614086 Enrollment ID: I20100701000016 |
| Provider Name | Michael Phillip Dorfman |
|---|---|
| Provider Type | Practitioner - Gastroenterology |
| Provider Identifiers | NPI Number: 1164658555 PECOS PAC ID: 2769640234 Enrollment ID: I20120607000427 |
| Provider Name | Daniel Joseph Zanchetti |
|---|---|
| Provider Type | Practitioner - Gastroenterology |
| Provider Identifiers | NPI Number: 1821257742 PECOS PAC ID: 7911139910 Enrollment ID: I20150515002058 |
| Provider Name | Keri A Herzog |
|---|---|
| Provider Type | Practitioner - Gastroenterology |
| Provider Identifiers | NPI Number: 1427292614 PECOS PAC ID: 7810289022 Enrollment ID: I20160708001075 |
| Provider Name | Kristin Macarthur |
|---|---|
| Provider Type | Practitioner - Gastroenterology |
| Provider Identifiers | NPI Number: 1225357809 PECOS PAC ID: 9739311648 Enrollment ID: I20160907000351 |
| Provider Name | Kenneth Barshop |
|---|---|
| Provider Type | Practitioner - Internal Medicine |
| Provider Identifiers | NPI Number: 1316396690 PECOS PAC ID: 2163716317 Enrollment ID: I20220225001875 |
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