Provider Demographics
NPI:1073546859
Name:EAR NOSE AND THROAT ASSOCIATES INC.
Entity Type:Organization
Organization Name:EAR NOSE AND THROAT ASSOCIATES INC.
Other - Org Name:EAR NOSE & THROAT ASSOC.
Other - Org Type:Doing Business As
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:AVRAHAM
Authorized Official - Middle Name:
Authorized Official - Last Name:HAMPEL
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:215-663-1121
Mailing Address - Street 1:375 TOWNSHIP LINE RD
Mailing Address - Street 2:
Mailing Address - City:ELKINS PARK
Mailing Address - State:PA
Mailing Address - Zip Code:19027
Mailing Address - Country:US
Mailing Address - Phone:215-663-1121
Mailing Address - Fax:215-663-1243
Practice Address - Street 1:375 TOWNSHIP LINE RD
Practice Address - Street 2:
Practice Address - City:ELKINS PARK
Practice Address - State:PA
Practice Address - Zip Code:19027
Practice Address - Country:US
Practice Address - Phone:215-663-1121
Practice Address - Fax:215-663-1243
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-07-07
Last Update Date:2010-09-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PAMD020113E207Y00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207Y00000XAllopathic & Osteopathic PhysiciansOtolaryngologyGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
PA0659388Medicaid
PA017055Medicare ID - Type Unspecified
PA0659388Medicaid