Provider Demographics
NPI:1265764104
Name:DIGESTIVE HEALTH SPECIALISTS, P.C.
Entity type:Organization
Organization Name:DIGESTIVE HEALTH SPECIALISTS, P.C.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRACTICE MANAGER
Authorized Official - Prefix:MS
Authorized Official - First Name:KAREN
Authorized Official - Middle Name:
Authorized Official - Last Name:DEMETROULAKOS
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:978-454-9811
Mailing Address - Street 1:4 MEETING HOUSE RD
Mailing Address - Street 2:SUITE 6-8
Mailing Address - City:CHELMSFORD
Mailing Address - State:MA
Mailing Address - Zip Code:01824-2766
Mailing Address - Country:US
Mailing Address - Phone:978-454-9811
Mailing Address - Fax:978-221-6245
Practice Address - Street 1:4 MEETING HOUSE RD
Practice Address - Street 2:SUITE 6-8
Practice Address - City:CHELMSFORD
Practice Address - State:MA
Practice Address - Zip Code:01824-2766
Practice Address - Country:US
Practice Address - Phone:978-454-9811
Practice Address - Fax:978-221-6245
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2010-02-03
Last Update Date:2014-10-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207RG0100XAllopathic & Osteopathic PhysiciansInternal MedicineGastroenterologyGroup - Multi-Specialty
No207L00000XAllopathic & Osteopathic PhysiciansAnesthesiologyGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
MA9765905Medicaid
MAM15374OtherBLUE CROSS & BLUE SHIELD
MA9765905Medicaid