Provider Demographics
NPI:1730695172
Name:CENTER FOR DIGESTIVE WELLNESS PC
Entity type:Organization
Organization Name:CENTER FOR DIGESTIVE WELLNESS PC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:ELLIOT
Authorized Official - Middle Name:J
Authorized Official - Last Name:FEINBERG
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:978-537-7552
Mailing Address - Street 1:1 EDWARD ST
Mailing Address - Street 2:
Mailing Address - City:CANTON
Mailing Address - State:MA
Mailing Address - Zip Code:02021-2303
Mailing Address - Country:US
Mailing Address - Phone:781-821-9510
Mailing Address - Fax:781-821-9513
Practice Address - Street 1:105 ERDMAN WAY
Practice Address - Street 2:
Practice Address - City:LEOMINSTER
Practice Address - State:MA
Practice Address - Zip Code:01453-1805
Practice Address - Country:US
Practice Address - Phone:978-537-7552
Practice Address - Fax:978-537-7383
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2017-12-21
Last Update Date:2017-12-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MA74135207RG0100X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207RG0100XAllopathic & Osteopathic PhysiciansInternal MedicineGastroenterologyGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
MAFEJ11036OtherBLUE CROSS BLUE SHIELD
MA110106163AMedicaid