Basic Information
| Provider Information | |||||||||
| NPI: | 1013005966 | ||||||||
| EntityType: | 2 | ||||||||
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| OrganizationName: | DIGESTIVE DISEASE CONSULTANTS, PC | ||||||||
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| Mailing Information | |||||||||
| Address1: | 1 LIBERTY SQ | ||||||||
| Address2: | SECOND FLOOR | ||||||||
| City: | NEW BRITAIN | ||||||||
| State: | CT | ||||||||
| PostalCode: | 060512637 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 8602299688 | ||||||||
| FaxNumber: | 8602295498 | ||||||||
| Practice Location | |||||||||
| Address1: | 1 LIBERTY SQ | ||||||||
| Address2: | SECOND FLOOR | ||||||||
| City: | NEW BRITAIN | ||||||||
| State: | CT | ||||||||
| PostalCode: | 060512637 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 8602299688 | ||||||||
| FaxNumber: | 8602295498 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 10/10/2006 | ||||||||
| LastUpdateDate: | 01/29/2008 | ||||||||
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| AuthorizedOfficialLastName: | FOSTER | ||||||||
| AuthorizedOfficialFirstName: | DEBORAH | ||||||||
| AuthorizedOfficialMiddleName: | L | ||||||||
| AuthorizedOfficialTitleorPosition: | PRACTICE MANAGER | ||||||||
| AuthorizedOfficialTelephone: | 8602299688 | ||||||||
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| IsOrganizationSubpart: | N | ||||||||
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| AuthorizedOfficialNamePrefix: | MRS. | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 363L00000X | N | 193400000X MULTIPLE SINGLE SPECIALTY GROUP | Physician Assistants & Advanced Practice Nursing Providers | Nurse Practitioner | 207RG0100X | Y | 193400000X MULTIPLE SINGLE SPECIALTY GROUP | Allopathic & Osteopathic Physicians | Internal Medicine | Gastroenterology |
ID Information
| ID | Type | State | Issuer | Description | 4065645 | 05 | CT | MEDICAID |