Organization
MARLBORO GASTROENTEROLOGY ASSOCIATES PA
Active
Other names
MARLBORO GI ENDOSCOPY CENTER
Organization subpart
No
Provider details
NPI number
Authorized official
MRS. PATRICIA J RIDDLE (OFFICE MGR ADMINISTRATOR)
(843) 479-9794
Entity
Organization
Contact information
Practice address
102 ENDO LN, HAMLET, NC 28345-4560
(910) 205-3035
(910) 205-3062
Mailing address
PO BOX 617, BENNETTSVILLE, SC 29512-0617
(843) 479-6268
(843) 479-8076
Taxonomy
Speciality
Code
Description
License number
State
207RG0100X
Gastroenterology Physician
10779
SC
207RG0100X
Gastroenterology Physician
Primary
27767
NC
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
0191F
BCBS GROUP
NC
05
—
890191F
—
NC
01
—
CF8544
RR MEDICARE
NC
01
—
DE8861
SC RR MEDICARE GROUP
SC
05
—
PC1896
—
SC
Enumeration date
03/16/2006
Last updated
05/19/2008
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