Provider Demographics
NPI:1962569111
Name:ADVANCED DIGESTIVE CARE P A
Entity type:Organization
Organization Name:ADVANCED DIGESTIVE CARE P A
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:UMESH
Authorized Official - Middle Name:
Authorized Official - Last Name:CHOUDHRY
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:727-462-0444
Mailing Address - Street 1:920 S MYRTLE AVE
Mailing Address - Street 2:STE#A
Mailing Address - City:CLEARWATER
Mailing Address - State:FL
Mailing Address - Zip Code:33756-3918
Mailing Address - Country:US
Mailing Address - Phone:727-462-0444
Mailing Address - Fax:727-462-0446
Practice Address - Street 1:920 S MYRTLE AVE
Practice Address - Street 2:STE#A
Practice Address - City:CLEARWATER
Practice Address - State:FL
Practice Address - Zip Code:33756-3918
Practice Address - Country:US
Practice Address - Phone:727-462-0444
Practice Address - Fax:727-462-0446
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-01-03
Last Update Date:2009-10-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLME68190207RG0100X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207RG0100XAllopathic & Osteopathic PhysiciansInternal MedicineGastroenterologyGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL=========OtherTIN