Basic Information
| Provider Information | |||||||||
| NPI: | 1013977552 | ||||||||
| EntityType: | 2 | ||||||||
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| OrganizationName: | THE OTOLARYNGOLOGY GROUP, P.C. | ||||||||
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| Mailing Information | |||||||||
| Address1: | PO BOX 1807 | ||||||||
| Address2: | |||||||||
| City: | MERRIMACK | ||||||||
| State: | NH | ||||||||
| PostalCode: | 030541807 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 6036739411 | ||||||||
| FaxNumber: | 6036739899 | ||||||||
| Practice Location | |||||||||
| Address1: | 111 OLD ROAD TO 9 ACRE COR | ||||||||
| Address2: | SUITE 490 | ||||||||
| City: | CONCORD | ||||||||
| State: | MA | ||||||||
| PostalCode: | 017424141 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 9783711400 | ||||||||
| FaxNumber: | 9783710246 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 03/27/2006 | ||||||||
| LastUpdateDate: | 12/06/2007 | ||||||||
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| AuthorizedOfficialLastName: | VOGEL | ||||||||
| AuthorizedOfficialFirstName: | DANIEL | ||||||||
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| AuthorizedOfficialTitleorPosition: | OWNER | ||||||||
| AuthorizedOfficialTelephone: | 9783711400 | ||||||||
| IsSoleProprietor: | |||||||||
| IsOrganizationSubpart: | N | ||||||||
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| AuthorizedOfficialCredential: | M.D. | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 207Y00000X | Y | 193400000X SINGLE SPECIALTY GROUP | Allopathic & Osteopathic Physicians | Otolaryngology |
ID Information
| ID | Type | State | Issuer | Description | 0012238 | 01 | MA | NEIGHBORHOOD HEALTH | OTHER | 1534327 | 01 | MA | UNITED MINE WORKERS OF AM | OTHER | 95846 | 01 | MA | AETNA | OTHER | M15183 | 01 | MA | BLUE CROSS BLUE SHIELD | OTHER | 9442 | 01 | MA | HEALTHSOURCE | OTHER | 600537 | 01 | MA | TUFTS | OTHER | CL3887 | 01 | MA | RAILROAD MEDICARE | OTHER | 9763171 | 05 | MA | MEDICAID |