Organization
CENTRAL PENN GASTROENTEROLOGY ASSOCIATES
Active
Organization subpart
No
Provider details
NPI number
Authorized official
DR. VLADIMIR PETORAK JR. MD (PRESIDENT)
(570) 524-2722
Entity
Organization
Contact information
Practice address
90 MEDICAL PARK DRIVE, LEWISBURG, PA 17837-9419
(570) 524-2722
(570) 524-0362
Mailing address
90 MEDICAL PARK DR, LEWISBURG, PA 17837-9419
(570) 524-2722
(570) 524-0362
Taxonomy
Speciality
Code
Description
License number
State
174400000X
Specialist
Primary
—
—
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
0018133010005
—
PA
Enumeration date
11/14/2005
Last updated
08/22/2020
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