Provider Demographics
NPI:1104934942
Name:GASTROENTEROLOGY ASSOCIATES, PEAR M. ENAM, M.D., PA
Entity type:Organization
Organization Name:GASTROENTEROLOGY ASSOCIATES, PEAR M. ENAM, M.D., PA
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OFFICE MANAGER
Authorized Official - Prefix:
Authorized Official - First Name:STACEY
Authorized Official - Middle Name:
Authorized Official - Last Name:BLIZZARD
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:301-733-4404
Mailing Address - Street 1:11110 MEDICAL CAMPUS RD
Mailing Address - Street 2:SUITE 250
Mailing Address - City:HAGERSTOWN
Mailing Address - State:MD
Mailing Address - Zip Code:21742-6700
Mailing Address - Country:US
Mailing Address - Phone:301-733-4404
Mailing Address - Fax:301-733-3984
Practice Address - Street 1:11110 MEDICAL CAMPUS RD
Practice Address - Street 2:SUITE 250
Practice Address - City:HAGERSTOWN
Practice Address - State:MD
Practice Address - Zip Code:21742-6700
Practice Address - Country:US
Practice Address - Phone:301-733-4404
Practice Address - Fax:301-733-3984
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-08-29
Last Update Date:2022-08-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes174400000XOther Service ProvidersSpecialistGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
2003711OtherAETNA - HMO - GOUP
4400511OtherAETNA - PPO - ENAM
1538148283OtherINDIVIDUAL NPI - CHOUDARI
526933-02OtherCAREFIRST - ENAM
1780687616OtherNPI INDIVIDUAL - ENAM
MD265001100Medicaid
5476652OtherAETNA - PPO - HANIF
5531514OtherAETNA - PPO - GROUP
2010644OtherAETNA - HANIF
1285637116OtherNPI INDIVIDUAL - HANIF
MD515001900Medicaid
MD606031500Medicaid
2123375OtherALLIANCE - ENAM
2123380OtherALLIANCE - HANIF
614460-02OtherCAREFIRST - HANIF
533100OtherAETNA - ENAM
2123380OtherALLIANCE - HANIF
G72928Medicare UPIN
MD265001100Medicaid
1285637116OtherNPI INDIVIDUAL - HANIF
MD331LMedicare ID - Type UnspecifiedGROUP NUMBER