Organization
BAYFRONT DIGESTIVE DISEASE ASSOCIATES PC
Active
Other names
Bayfront Digestive Disease
Organization subpart
No
Provider details
NPI number
Authorized official
MRS. TINA M CASILLO (PRACTICE ADMINISTRATOR)
(814) 456-7733
Entity
Organization
Contact information
Practice address
100 PEACH ST, SUITE 200, ERIE, PA 16507-1411
(814) 456-7733
(814) 456-7213
Mailing address
100 PEACH ST, SUITE 200, ERIE, PA 16507-1411
(814) 456-7733
(814) 456-7213
Taxonomy
Speciality
Code
Description
License number
State
207RG0100X
Gastroenterology Physician
Primary
—
PA
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
0010182600013
—
PA
05
—
0609354
—
OH
01
—
B185348
HIGHMARK BLUE SHIELD GRP
PA
Enumeration date
06/01/2006
Last updated
11/13/2009
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