Provider Demographics
NPI:1164462669
Name:HUNTINGDON GASTROENTEROLOGY ASSOCIATES
Entity type:Organization
Organization Name:HUNTINGDON GASTROENTEROLOGY ASSOCIATES
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PARTNER
Authorized Official - Prefix:
Authorized Official - First Name:KEITH
Authorized Official - Middle Name:A
Authorized Official - Last Name:WADDLE
Authorized Official - Suffix:
Authorized Official - Credentials:DO
Authorized Official - Phone:814-643-1141
Mailing Address - Street 1:820 BRYAN ST
Mailing Address - Street 2:SUITE 1
Mailing Address - City:HUNTINGDON
Mailing Address - State:PA
Mailing Address - Zip Code:16652-2414
Mailing Address - Country:US
Mailing Address - Phone:814-643-1141
Mailing Address - Fax:814-643-9451
Practice Address - Street 1:820 BRYAN ST
Practice Address - Street 2:SUITE 1
Practice Address - City:HUNTINGDON
Practice Address - State:PA
Practice Address - Zip Code:16652-2414
Practice Address - Country:US
Practice Address - Phone:814-643-1141
Practice Address - Fax:814-643-9451
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-06-07
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207RG0100XAllopathic & Osteopathic PhysiciansInternal MedicineGastroenterologyGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
PA743142OtherHIGHMARK
PA743142Medicare ID - Type Unspecified