Provider Demographics
NPI:1023184413
Name:CAROLINA EAR NOSE & THROAT PA
Entity Type:Organization
Organization Name:CAROLINA EAR NOSE & THROAT PA
Other - Org Name:MAGDA R PUGH MD PA
Other - Org Type:Former Legal Business Name
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:TIMOTHY
Authorized Official - Middle Name:J
Authorized Official - Last Name:HEFFRON
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:919-790-2255
Mailing Address - Street 1:10880 DURANT RD STE 124
Mailing Address - Street 2:
Mailing Address - City:RALEIGH
Mailing Address - State:NC
Mailing Address - Zip Code:27614-6629
Mailing Address - Country:US
Mailing Address - Phone:919-790-2255
Mailing Address - Fax:919-865-2875
Practice Address - Street 1:10880 DURANT RD STE 124
Practice Address - Street 2:
Practice Address - City:RALEIGH
Practice Address - State:NC
Practice Address - Zip Code:27614-6629
Practice Address - Country:US
Practice Address - Phone:919-790-2255
Practice Address - Fax:919-865-2875
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-11-28
Last Update Date:2019-01-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207Y00000XAllopathic & Osteopathic PhysiciansOtolaryngologyGroup - Single Specialty