Provider Demographics
NPI:1174803076
Name:EAR, NOSE & THROAT ASSOCIATES
Entity type:Organization
Organization Name:EAR, NOSE & THROAT ASSOCIATES
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OFFICE MANAGER
Authorized Official - Prefix:MRS
Authorized Official - First Name:DENISE
Authorized Official - Middle Name:
Authorized Official - Last Name:WINGERD
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:410-821-5154
Mailing Address - Street 1:6565 N CHARLES ST
Mailing Address - Street 2:PPE 601
Mailing Address - City:BALTIMORE
Mailing Address - State:MD
Mailing Address - Zip Code:21204-6800
Mailing Address - Country:US
Mailing Address - Phone:410-821-5151
Mailing Address - Fax:410-823-8309
Practice Address - Street 1:6565 N CHARLES ST
Practice Address - Street 2:PPE 601
Practice Address - City:BALTIMORE
Practice Address - State:MD
Practice Address - Zip Code:21204-6800
Practice Address - Country:US
Practice Address - Phone:410-821-5151
Practice Address - Fax:410-823-8309
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2011-08-23
Last Update Date:2011-08-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MD667638231H00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes231H00000XSpeech, Language and Hearing Service ProvidersAudiologistGroup - Single Specialty