Basic Information
Provider Information
NPI: 1366793465
EntityType: 2
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OrganizationName: CHARLOTTE EYE EAR NOSE & THROAT ASSOCIATES, PA
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Mailing Information
Address1: 6035 FAIRVIEW RD
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City: CHARLOTTE
State: NC
PostalCode: 282103256
CountryCode: US
TelephoneNumber: 7042953000
FaxNumber: 7042953468
Practice Location
Address1: 114 GATEWAY BLVD
Address2: SUITE B
City: MOORESVILLE
State: NC
PostalCode: 281175598
CountryCode: US
TelephoneNumber: 7047997250
FaxNumber: 7046632447
Other Information
ProviderEnumerationDate: 09/28/2012
LastUpdateDate: 04/30/2013
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AuthorizedOfficialLastName: GILL
AuthorizedOfficialFirstName: JAG
AuthorizedOfficialMiddleName: S
AuthorizedOfficialTitleorPosition: CEO
AuthorizedOfficialTelephone: 7042953000
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IsOrganizationSubpart: N
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AuthorizedOfficialCredential: SCD
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Taxonomy Information
TaxonomyLicenseStateSwitchTaxonomyGroupTaxonomyTypeTaxonomyClassSubSpecialty
207YS0123X  N193200000X MULTI-SPECIALTY GROUPAllopathic & Osteopathic PhysiciansOtolaryngologyFacial Plastic Surgery
231H00000X  N193200000X MULTI-SPECIALTY GROUPSpeech, Language and Hearing Service ProvidersAudiologist 
237600000X  N193200000X MULTI-SPECIALTY GROUPSpeech, Language and Hearing Service ProvidersAudiologist-Hearing Aid Fitter 
207Y00000X  Y193200000X MULTI-SPECIALTY GROUPAllopathic & Osteopathic PhysiciansOtolaryngology 

No ID Information.


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