Basic Information
| Provider Information | |||||||||
| NPI: | 1588852198 | ||||||||
| EntityType: | 2 | ||||||||
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| OrganizationName: | EAR, NOSE, THROAT, AND ALLERGY ASSOCIATES,LLC | ||||||||
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| Mailing Information | |||||||||
| Address1: | 2700 SILVERSIDE RD | ||||||||
| Address2: | SUITE 3A | ||||||||
| City: | WILMINGTON | ||||||||
| State: | DE | ||||||||
| PostalCode: | 198103719 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 3024789878 | ||||||||
| FaxNumber: | 3024788069 | ||||||||
| Practice Location | |||||||||
| Address1: | 2700 SILVERSIDE RD | ||||||||
| Address2: | SUITE 3A | ||||||||
| City: | WILMINGTON | ||||||||
| State: | DE | ||||||||
| PostalCode: | 198103719 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 3024789878 | ||||||||
| FaxNumber: | 3024788069 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 10/09/2007 | ||||||||
| LastUpdateDate: | 07/01/2008 | ||||||||
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| AuthorizedOfficialLastName: | IMBER | ||||||||
| AuthorizedOfficialFirstName: | CINDY | ||||||||
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| AuthorizedOfficialTitleorPosition: | OFFICE MANAGER | ||||||||
| AuthorizedOfficialTelephone: | 3024789878 | ||||||||
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| IsOrganizationSubpart: | N | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 207Y00000X | Y | 193400000X SINGLE SPECIALTY GROUP | Allopathic & Osteopathic Physicians | Otolaryngology |
No ID Information.