| Organization Name: | MARLBORO GASTROENTEROLOGY ASSOCIATES PA |
| NPI Number: | 1609940352 |
| Entity Type Code: | Organizational (2) |
| Authorized Official Name: | PATRICIA J RIDDLE (ADMINISTRATOR) |
| Mailing Address: | 102 Endo Ln Suite 1 Hamlet |
| State: | NC US |
| Postal Code: | 283454560 |
| Phone Number: | 9105823636 |
| Fax Number: | 9102052251 |
| NPI Enumeration Date: | 11/17/2006 |
| NPI Last Update Date: | 06/17/2008 |
| Replacement NPI: | 0 |
| NPI Deactivation Date: | |
| NPI Reactivation Date: |
Taxonomy Information: | |
| Healthcare Provider Taxonomy: | 261QE0800X |
| License Number: | AS0083 |
| Healthcare Provider Taxonomy: (Secondary) | N |
| State: | NC |
| Taxonomy Type: | Ambulatory Health Care Facilities |
| Taxonomy Classification: | Clinic/Center |
| Taxonomy Specialization: | Endoscopy |
| Taxonomy Definition: | |