Provider Demographics
NPI:1184779639
Name:GASTROENTEROLOGY ASSOCIATES INC
Entity type:Organization
Organization Name:GASTROENTEROLOGY ASSOCIATES INC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:DOCTOR
Authorized Official - Prefix:
Authorized Official - First Name:SANJIV
Authorized Official - Middle Name:
Authorized Official - Last Name:KHETARPAL
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:330-493-1480
Mailing Address - Street 1:PO BOX 36329
Mailing Address - Street 2:
Mailing Address - City:CANTON
Mailing Address - State:OH
Mailing Address - Zip Code:44735-6329
Mailing Address - Country:US
Mailing Address - Phone:330-493-1480
Mailing Address - Fax:330-493-6805
Practice Address - Street 1:4665 BELPAR ST NW
Practice Address - Street 2:
Practice Address - City:CANTON
Practice Address - State:OH
Practice Address - Zip Code:44718-3602
Practice Address - Country:US
Practice Address - Phone:330-493-1480
Practice Address - Fax:330-493-6805
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-01-24
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
OH0405565Medicaid
9913842Medicare ID - Type Unspecified