Provider Demographics
NPI:1518959360
Name:GASTROENTEROLOGY ASSOCIATES LTD
Entity type:Organization
Organization Name:GASTROENTEROLOGY ASSOCIATES LTD
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:JACOB
Authorized Official - Middle Name:HARRY
Authorized Official - Last Name:PICKLE
Authorized Official - Suffix:IV
Authorized Official - Credentials:MD
Authorized Official - Phone:610-439-8551
Mailing Address - Street 1:3131 COLLEGE HEIGHTS BLVD
Mailing Address - Street 2:
Mailing Address - City:ALLENTOWN
Mailing Address - State:PA
Mailing Address - Zip Code:18104-4812
Mailing Address - Country:US
Mailing Address - Phone:610-439-8551
Mailing Address - Fax:610-439-1435
Practice Address - Street 1:3131 COLLEGE HEIGHTS BLVD
Practice Address - Street 2:
Practice Address - City:ALLENTOWN
Practice Address - State:PA
Practice Address - Zip Code:18104-4812
Practice Address - Country:US
Practice Address - Phone:610-439-8551
Practice Address - Fax:610-439-1435
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2005-08-18
Last Update Date:2018-09-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207RG0100XAllopathic & Osteopathic PhysiciansInternal MedicineGastroenterologyGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
PA1007340280001Medicaid
PAGA449251Medicare PIN