Organization
SUBURBAN GASTROENTEROLOGY ASSOCIATES INC
Active
Organization
SUBURBAN GASTROENTEROLOGY ASSOCIATES INC
Active
Organization subpart
No
Provider details
NPI number
Authorized official
MARK JACOBS MD (PRESIDENT)
(610) 789-3510
Entity
Organization
Contact information
Practice address
1010 WEST CHESTER PIKE, STE 202, HAVERTOWN, PA 19083-3442
(610) 789-3510
(610) 789-3591
Mailing address
1010 WEST CHESTER PIKE, STE 202, HAVERTOWN, PA 19083-3442
(610) 789-3510
(610) 789-3591
Taxonomy
Speciality
Code
Description
License number
State
207RG0100X
Gastroenterology Physician
Primary
—
—
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
078329002
—
PA
01
—
CF6518
RAILROAD MEDICARE
PA
Enumeration date
07/13/2006
Last updated
05/15/2008
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