East Coast Gastroenterology Llc | |
1450 Mercantile Ln Suite 217 Largo MD 20774-5376 | |
(301) 583-7770 | |
(301) 583-9414 |
Full Name | East Coast Gastroenterology Llc |
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Speciality | Internal Medicine - Gastroenterology |
Location | 1450 Mercantile Ln, Largo, Maryland |
Authorized Official Name and Position | Michael Robert Nichols (CREDENTIALING REPRESENTATIVE) |
Authorized Official Contact | 4102586333 |
Accepts Medicare Insurance | This clinic does not participate in Medicare Program. |
Mailing Address | Practice Location Address |
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East Coast Gastroenterology Llc Po Box 62249 Baltimore MD 21264-2249 Ph: (301) 583-7770 | East Coast Gastroenterology Llc 1450 Mercantile Ln Suite 217 Largo MD 20774-5376 Ph: (301) 583-7770 |
NPI Number | 1992998975 |
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Provider Enumeration Date | 08/22/2007 |
Last Update Date | 12/05/2008 |
Identifier | Type | State | Issuer |
---|---|---|---|
1992998975 | NPI | - | NPPES |
Taxonomy | Type | License (State) | Status |
---|---|---|---|
207RG0100X | Internal Medicine - Gastroenterology | (* (Not Available)) | Primary |
207ZC0006X | Pathology - Clinical Pathology | (* (Not Available)) | Secondary |
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Ibe Pc Primary Care Clinic Medicare: Not Enrolled in Medicare Practice Location: 9500 Medical Center Dr Ste 105, Largo, MD 20774 Phone: 301-615-4133 Fax: 240-245-2918 | |
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