| Park Gastroenterology, Pllc | |
|
7560 Carpenter Fire Station Rd Ste 303 Cary NC 27519-9637 | |
| (919) 650-6461 | |
| Not Available |
| Full Name | Park Gastroenterology, Pllc |
|---|---|
| Speciality | Internal Medicine |
| Location | 7560 Carpenter Fire Station Rd Ste 303, Cary, North Carolina |
| Authorized Official Name and Position | Vallisitaram Prasad Kodali (OWNER) |
| Authorized Official Contact | 9196506461 |
| Accepts Medicare Insurance | Yes. This clinic participates in medicare program and accept medicare insurance. |
| Mailing Address | Practice Location Address |
|---|---|
| Park Gastroenterology, Pllc 7560 Carpenter Fire Station Rd Ste 303 Cary NC 27519-9637 Ph: (919) 650-6461 | Park Gastroenterology, Pllc 7560 Carpenter Fire Station Rd Ste 303 Cary NC 27519-9637 Ph: (919) 650-6461 |
| NPI Number | 1346889292 |
|---|---|
| Provider Enumeration Date | 12/24/2019 |
| Last Update Date | 12/24/2019 |
| Medicare PECOS PAC ID | 5496183733 |
|---|---|
| Medicare Enrollment ID | O20200319001153 |
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1346889292 | NPI | - | NPPES |
| Taxonomy | Type | License (State) | Status |
|---|---|---|---|
| 207RG0100X | Internal Medicine - Gastroenterology | (* (Not Available)) | Primary |
| Provider Name | Vallisitaram Kodali |
|---|---|
| Provider Type | Practitioner - Gastroenterology |
| Provider Identifiers | NPI Number: 1609809920 PECOS PAC ID: 7315964178 Enrollment ID: I20051031000926 |
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