Basic Information
| Provider Information | |||||||||
| NPI: | 1396075123 | ||||||||
| EntityType: | 2 | ||||||||
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| OrganizationName: | INTEGRATED GASTROENTEROLOGY CONSULTANTS, PC | ||||||||
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| Mailing Information | |||||||||
| Address1: | 20 RESEARCH PL | ||||||||
| Address2: | SUITE 220 | ||||||||
| City: | NORTH CHELMSFORD | ||||||||
| State: | MA | ||||||||
| PostalCode: | 018632454 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 9784596737 | ||||||||
| FaxNumber: | 9784592580 | ||||||||
| Practice Location | |||||||||
| Address1: | 20 RESEARCH PL | ||||||||
| Address2: | SUITE 220 | ||||||||
| City: | NORTH CHELMSFORD | ||||||||
| State: | MA | ||||||||
| PostalCode: | 018632454 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 9784596737 | ||||||||
| FaxNumber: | 9784592580 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 12/29/2009 | ||||||||
| LastUpdateDate: | 01/14/2020 | ||||||||
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| AuthorizedOfficialLastName: | MARINELLI | ||||||||
| AuthorizedOfficialFirstName: | FRANKLIN | ||||||||
| AuthorizedOfficialMiddleName: | CHARLES | ||||||||
| AuthorizedOfficialTitleorPosition: | PRESIDENT | ||||||||
| AuthorizedOfficialTelephone: | 9784542522 | ||||||||
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| IsOrganizationSubpart: | N | ||||||||
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| AuthorizedOfficialCredential: | M.D. | ||||||||
| NPICertificationDate: | 01/14/2020 | ||||||||
Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 207L00000X | N | 193200000X MULTI-SPECIALTY GROUP | Allopathic & Osteopathic Physicians | Anesthesiology | 207RG0100X | N | 193200000X MULTI-SPECIALTY GROUP | Allopathic & Osteopathic Physicians | Internal Medicine | Gastroenterology | 225100000X | Y | 193200000X MULTI-SPECIALTY GROUP | Respiratory, Developmental, Rehabilitative and Restorative Service Providers | Physical Therapist |
No ID Information.