Basic Information
| Provider Information | |||||||||
| NPI: | 1265764104 | ||||||||
| EntityType: | 2 | ||||||||
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| OrganizationName: | DIGESTIVE HEALTH SPECIALISTS, P.C. | ||||||||
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| Mailing Information | |||||||||
| Address1: | 4 MEETING HOUSE RD | ||||||||
| Address2: | SUITE 6-8 | ||||||||
| City: | CHELMSFORD | ||||||||
| State: | MA | ||||||||
| PostalCode: | 018242766 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 9784549811 | ||||||||
| FaxNumber: | 9782216245 | ||||||||
| Practice Location | |||||||||
| Address1: | 4 MEETING HOUSE RD | ||||||||
| Address2: | SUITE 6-8 | ||||||||
| City: | CHELMSFORD | ||||||||
| State: | MA | ||||||||
| PostalCode: | 018242766 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 9784549811 | ||||||||
| FaxNumber: | 9782216245 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 02/03/2010 | ||||||||
| LastUpdateDate: | 10/24/2014 | ||||||||
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| AuthorizedOfficialLastName: | DEMETROULAKOS | ||||||||
| AuthorizedOfficialFirstName: | KAREN | ||||||||
| AuthorizedOfficialMiddleName: | |||||||||
| AuthorizedOfficialTitleorPosition: | PRACTICE MANAGER | ||||||||
| AuthorizedOfficialTelephone: | 9784549811 | ||||||||
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| IsOrganizationSubpart: | N | ||||||||
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| AuthorizedOfficialNamePrefix: | MS. | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 207L00000X | N | 193200000X MULTI-SPECIALTY GROUP | Allopathic & Osteopathic Physicians | Anesthesiology | 207RG0100X | Y | 193200000X MULTI-SPECIALTY GROUP | Allopathic & Osteopathic Physicians | Internal Medicine | Gastroenterology |
ID Information
| ID | Type | State | Issuer | Description | 9765905 | 05 | MA | MEDICAID | M15374 | 01 | MA | BLUE CROSS & BLUE SHIELD | OTHER |