Provider Demographics
NPI:1215248737
Name:BEL AIR GASTROENTEROLOGY, LLC
Entity type:Organization
Organization Name:BEL AIR GASTROENTEROLOGY, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PHYSICIAN
Authorized Official - Prefix:DR
Authorized Official - First Name:MOORKATH
Authorized Official - Middle Name:S
Authorized Official - Last Name:UNNI
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:410-803-2211
Mailing Address - Street 1:703 NICHOLAS LN
Mailing Address - Street 2:
Mailing Address - City:COCKEYSVILLE
Mailing Address - State:MD
Mailing Address - Zip Code:21030-1319
Mailing Address - Country:US
Mailing Address - Phone:410-803-2211
Mailing Address - Fax:410-420-9841
Practice Address - Street 1:602 S ATWOOD RD
Practice Address - Street 2:SUITE 205
Practice Address - City:BEL AIR
Practice Address - State:MD
Practice Address - Zip Code:21014-4172
Practice Address - Country:US
Practice Address - Phone:410-803-2211
Practice Address - Fax:410-420-9841
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2010-06-30
Last Update Date:2010-06-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MDD0051090174400000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes174400000XOther Service ProvidersSpecialistGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
MD213100500Medicaid
MD213100500Medicaid