# EAST COAST GASTROENTEROLOGY LLC

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- **Entity:** Organization
- **Status:** Active
- **Organization subpart:** No

## Provider details

- **NPI number:** 1992998975
- **Authorized official:** MICHAEL ROBERT NICHOLS (CREDENTIALING REPRESENTATIVE)
- **Authorized official phone:** (410) 258-6333

## Contact information

- **Practice address:** 1450 MERCANTILE LN, SUITE 217, LARGO, MD 20774-5376
- **Practice address phone:** (301) 583-7770
- **Practice address fax:** (301) 583-9414
- **Mailing address:** PO BOX 62249, BALTIMORE, MD 21264-2249
- **Mailing address phone:** (301) 583-7770
- **Mailing address fax:** (301) 583-9414

## Taxonomy

| Code | Description | License number | State | Primary |
| --- | --- | --- | --- | --- |
| 207RG0100X | Gastroenterology Physician | — | NULL | Yes |
| 207RG0100X | Gastroenterology Physician | — | — | Yes |
| 207ZC0006X | Clinical Pathology Physician | — | NULL | — |
| 207ZC0006X | Clinical Pathology Physician | — | — | — |

## Other

- **Enumeration date:** 08/22/2007
- **Last updated:** 12/05/2008