Basic Information
| Provider Information | |||||||||
| NPI: | 1902991151 | ||||||||
| EntityType: | 2 | ||||||||
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| OrganizationName: | FALL HILL GASTROENTEROLOGY ASSOCIATES, LTD. | ||||||||
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| Mailing Information | |||||||||
| Address1: | 2601 FALL HILL AVE | ||||||||
| Address2: | |||||||||
| City: | FREDERICKSBURG | ||||||||
| State: | VA | ||||||||
| PostalCode: | 224013323 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 5403719696 | ||||||||
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| Practice Location | |||||||||
| Address1: | 2601 FALL HILL AVE | ||||||||
| Address2: | |||||||||
| City: | FREDERICKSBURG | ||||||||
| State: | VA | ||||||||
| PostalCode: | 224013323 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 5403719696 | ||||||||
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| Other Information | |||||||||
| ProviderEnumerationDate: | 10/04/2006 | ||||||||
| LastUpdateDate: | 01/30/2014 | ||||||||
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| AuthorizedOfficialLastName: | BONIFACE | ||||||||
| AuthorizedOfficialFirstName: | JOHN | ||||||||
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| AuthorizedOfficialTitleorPosition: | MANAGING PHYSICIAN | ||||||||
| AuthorizedOfficialTelephone: | 5403719696 | ||||||||
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| IsOrganizationSubpart: | N | ||||||||
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| AuthorizedOfficialNameSuffix: | JR. | ||||||||
| AuthorizedOfficialCredential: | M.D. | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 207RG0100X | Y | 193400000X SINGLE SPECIALTY GROUP | Allopathic & Osteopathic Physicians | Internal Medicine | Gastroenterology |
No ID Information.