Provider Demographics
NPI:1144264896
Name:GASTROENTEROLOGY SPECIALISTS, P.A.
Entity type:Organization
Organization Name:GASTROENTEROLOGY SPECIALISTS, P.A.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:MUSHTAQ
Authorized Official - Middle Name:AHMAD
Authorized Official - Last Name:BUKHARI
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:828-437-7702
Mailing Address - Street 1:107B MICA AVE
Mailing Address - Street 2:
Mailing Address - City:MORGANTON
Mailing Address - State:NC
Mailing Address - Zip Code:28655-8135
Mailing Address - Country:US
Mailing Address - Phone:828-437-7702
Mailing Address - Fax:828-437-7930
Practice Address - Street 1:107B MICA AVE
Practice Address - Street 2:
Practice Address - City:MORGANTON
Practice Address - State:NC
Practice Address - Zip Code:28655-8135
Practice Address - Country:US
Practice Address - Phone:828-437-7702
Practice Address - Fax:828-437-7930
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-06-15
Last Update Date:2013-12-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC207R00000X, 207RG0100X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207RG0100XAllopathic & Osteopathic PhysiciansInternal MedicineGastroenterologyGroup - Multi-Specialty
No207R00000XAllopathic & Osteopathic PhysiciansInternal MedicineGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
NC8919660Medicaid
10904OtherBCBS
C856501Medicare UPIN
F5557Medicare UPIN
NC8919660Medicaid