Provider Demographics
NPI:1992809628
Name:EASTERN SHORES GASTROENTEROLOGY ASSOC
Entity type:Organization
Organization Name:EASTERN SHORES GASTROENTEROLOGY ASSOC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PHYSICIAN PARTNER
Authorized Official - Prefix:
Authorized Official - First Name:ROBERT
Authorized Official - Middle Name:C
Authorized Official - Last Name:DECKMANN
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:302-645-9325
Mailing Address - Street 1:33663 BAYVIEW MEDICAL DR
Mailing Address - Street 2:UNIT 2
Mailing Address - City:LEWES
Mailing Address - State:DE
Mailing Address - Zip Code:19958-1663
Mailing Address - Country:US
Mailing Address - Phone:302-645-9325
Mailing Address - Fax:302-645-5214
Practice Address - Street 1:33663 BAYVIEW MEDICAL DR
Practice Address - Street 2:UNIT 2
Practice Address - City:LEWES
Practice Address - State:DE
Practice Address - Zip Code:19958-1663
Practice Address - Country:US
Practice Address - Phone:302-645-9325
Practice Address - Fax:302-645-5214
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-09-12
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207RG0100XAllopathic & Osteopathic PhysiciansInternal MedicineGastroenterologyGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
DE0000513804Medicaid
DE0000513804Medicaid