| Modesto Gastroenterology Medical Corporation | |
|
2336 Sylvan Ave Suite A Modesto CA 95355-9211 | |
| (209) 338-0292 | |
| (209) 338-0298 |
| Full Name | Modesto Gastroenterology Medical Corporation |
|---|---|
| Speciality | Internal Medicine |
| Location | 2336 Sylvan Ave, Modesto, California |
| Authorized Official Name and Position | Elsakr Magdy (PRESIDENT) |
| Authorized Official Contact | 2093380292 |
| Accepts Medicare Insurance | Yes. This clinic participates in medicare program and accept medicare insurance. |
| Mailing Address | Practice Location Address |
|---|---|
| Modesto Gastroenterology Medical Corporation 2336 Sylvan Ave Suite A Modesto CA 95355-9211 Ph: (209) 338-0292 | Modesto Gastroenterology Medical Corporation 2336 Sylvan Ave Suite A Modesto CA 95355-9211 Ph: (209) 338-0292 |
| NPI Number | 1881748846 |
|---|---|
| Provider Enumeration Date | 01/23/2007 |
| Last Update Date | 12/27/2022 |
| Medicare PECOS PAC ID | 8628065687 |
|---|---|
| Medicare Enrollment ID | O20040429001497 |
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1881748846 | NPI | - | NPPES |
| DD2244 | Other | CA | MEDICARE ID |
| Taxonomy | Type | License (State) | Status |
|---|---|---|---|
| 207RG0100X | Internal Medicine - Gastroenterology | A45724 (California) | Primary |
| Provider Name | Magdy S Elsakr |
|---|---|
| Provider Type | Practitioner - Gastroenterology |
| Provider Identifiers | NPI Number: 1184676785 PECOS PAC ID: 3971590936 Enrollment ID: I20040504001475 |
| Provider Name | Ted Farzaneh |
|---|---|
| Provider Type | Practitioner - Pathology |
| Provider Identifiers | NPI Number: 1225588510 PECOS PAC ID: 5890073712 Enrollment ID: I20180606002821 |
| Provider Name | Eva Lili Rivera |
|---|---|
| Provider Type | Practitioner - Nurse Practitioner |
| Provider Identifiers | NPI Number: 1700222627 PECOS PAC ID: 4789939364 Enrollment ID: I20180622001153 |
| Provider Name | Sumeet Minhas |
|---|---|
| Provider Type | Practitioner - Nurse Practitioner |
| Provider Identifiers | NPI Number: 1780371914 PECOS PAC ID: 8022476373 Enrollment ID: I20230620001519 |
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