Basic Information
| Provider Information | |||||||||
| NPI: | 1942218896 | ||||||||
| EntityType: | 2 | ||||||||
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| OrganizationName: | POCONO GASTROENTEROLOGY PC | ||||||||
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| Mailing Information | |||||||||
| Address1: | 175 EAST BROWN STREET | ||||||||
| Address2: | SUITE 201A | ||||||||
| City: | EAST STROUDSBURG | ||||||||
| State: | PA | ||||||||
| PostalCode: | 183013098 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 5704247764 | ||||||||
| FaxNumber: | 5704210760 | ||||||||
| Practice Location | |||||||||
| Address1: | 175 EAST BROWN STREET | ||||||||
| Address2: | SUITE 201A | ||||||||
| City: | EAST STROUDSBURG | ||||||||
| State: | PA | ||||||||
| PostalCode: | 183013098 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 5704247764 | ||||||||
| FaxNumber: | 5704210760 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 08/04/2006 | ||||||||
| LastUpdateDate: | 08/22/2020 | ||||||||
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| AuthorizedOfficialLastName: | COHAN | ||||||||
| AuthorizedOfficialFirstName: | CHARLES | ||||||||
| AuthorizedOfficialMiddleName: | P | ||||||||
| AuthorizedOfficialTitleorPosition: | PRES CEO | ||||||||
| AuthorizedOfficialTelephone: | 5704247764 | ||||||||
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| IsOrganizationSubpart: | N | ||||||||
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| AuthorizedOfficialCredential: | DO | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 207RG0100X | MD042891L | PA | N | 193400000X MULTIPLE SINGLE SPECIALTY GROUP | Allopathic & Osteopathic Physicians | Internal Medicine | Gastroenterology | 207RG0100X | OS009950L | PA | Y | 193400000X MULTIPLE SINGLE SPECIALTY GROUP | Allopathic & Osteopathic Physicians | Internal Medicine | Gastroenterology |
No ID Information.