Central Penn Gastroenterology Associates

Primary specialty

SpecialistTaxonomy code 174400000X

Legal business name

CENTRAL PENN GASTROENTEROLOGY ASSOCIATES

Practice address

90 Medical Park Drive
Lewisburg, PA 17837-9419

Phone

(570) 524-2722

Fax

(570) 524-0362

NPI assigned

Nov 14, 2005

Last updated

Aug 22, 2020By the provider in NPPES

Organization subpart

No

Registry information is reported by the provider to CMS and is not verified. About this source

Authorized official

Name

Dr. Vladimir Petorak Jr., MDNPI 1871575134

Title

President

Phone

(570) 524-2722

Specialties & licenses 1

Addresses

Other identifiers 1

Locations

Practitioners 1

Individual providers connected to this organization through Medicare benefit reassignment, Care Compare group membership or National Provider Directory roles, and the practitioner matching its NPPES authorized official.

• Vladimir Petorak Jr., MD

  • Gastroenterology Physician
  • Lewisburg, PA
  • NPI 1871575134
  Authorized official Same address or phone

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1131926400000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1598054400000",
    "number": "1982686226",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "90 MEDICAL PARK DR",
            "city": "LEWISBURG",
            "state": "PA",
            "postal_code": "178379419",
            "telephone_number": "570-524-2722",
            "fax_number": "570-524-0362"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "90 MEDICAL PARK DRIVE",
            "city": "LEWISBURG",
            "state": "PA",
            "postal_code": "178379419",
            "telephone_number": "570-524-2722",
            "fax_number": "570-524-0362"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "CENTRAL PENN GASTROENTEROLOGY ASSOCIATES",
        "organizational_subpart": "NO",
        "enumeration_date": "2005-11-14",
        "last_updated": "2020-08-22",
        "status": "A",
        "authorized_official_last_name": "PETORAK",
        "authorized_official_first_name": "VLADIMIR",
        "authorized_official_title_or_position": "PRESIDENT",
        "authorized_official_telephone_number": "570-524-2722",
        "authorized_official_name_prefix": "Dr.",
        "authorized_official_name_suffix": "Jr.",
        "authorized_official_credential": "MD"
    },
    "taxonomies": [
        {
            "code": "174400000X",
            "taxonomy_group": "193400000X SINGLE SPECIALTY  GROUP",
            "desc": "Specialist",
            "state": null,
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "0018133010005",
            "state": "PA"
        }
    ],
    "endpoints": [],
    "other_names": []
}

• Angela W. Cassel, CNM
• David M Castellan, M.D.
• Kirsten Castrilli
• Center for Mindful Living, LLC
• Central PA Counseling, PLLC
• Central Penn Mobile Wound Care
• Central Pennsylvania Cardiology Associates LLC
• Central Susquehanna Surgical Specialists, P.C.
• Seth Edward Chamberlain, B.S.
• Shane Chamberlin, BSL

• Specialist in Lewisburg, PA
• Providers in Lewisburg, PA by specialty
• Specialist in Pennsylvania

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Aug 22, 2020; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.