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Organization
EAST COAST GASTROENTEROLOGY LLC
Active
Organization
EAST COAST GASTROENTEROLOGY LLC
Active
Organization subpart
No
Provider details
NPI number
Authorized official
MICHAEL ROBERT NICHOLS (CREDENTIALING REPRESENTATIVE)
(410) 258-6333
Entity
Organization
Contact information
Practice address
1450 MERCANTILE LN, SUITE 217, LARGO, MD 20774-5376
(301) 583-7770
(301) 583-9414
Mailing address
PO BOX 62249, BALTIMORE, MD 21264-2249
(301) 583-7770
(301) 583-9414
Taxonomy
Speciality
Code
Description
License number
State
207RG0100X
Gastroenterology Physician
Primary
—
NULL
207RG0100X
Gastroenterology Physician
Primary
—
—
207ZC0006X
Clinical Pathology Physician
—
NULL
207ZC0006X
Clinical Pathology Physician
—
—
Other
Enumeration date
08/22/2007
Last updated
12/05/2008
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