Organization
NORTHEASTERN GASTROENTEROLOGY ASSOCIATES, PC
Active
Organization
NORTHEASTERN GASTROENTEROLOGY ASSOCIATES, PC
Active
Organization subpart
No
Provider details
NPI number
Authorized official
DR. DAVID DEWITT REYNOLDS M.D. (PRESIDENT)
(570) 253-3991
Entity
Organization
Contact information
Practice address
1860 FAIR AVE, SUITE A, HONESDALE, PA 18431-2108
(570) 253-3391
(570) 253-1811
Mailing address
1860 FAIR AVE, SUITE A, HONESDALE, PA 18431-2108
(570) 253-3391
(570) 253-1811
Taxonomy
Speciality
Code
Description
License number
State
207RG0100X
Gastroenterology Physician
Primary
—
—
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
0016721410006
—
PA
01
—
0450817000
AMERIHEALTH & INDEP BS
—
01
—
2400697
GHI
—
01
—
66362
BLUE SHIELD
PA
01
—
77790
BLUE SHIELD 65 SPECIAL
PA
01
—
804251
FIRST PRIORITY
PA
Enumeration date
08/11/2006
Last updated
05/18/2016
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