Provider Demographics
NPI:1073575973
Name:CEDAR CREST ENT ASSOCIATES P.C.
Entity Type:Organization
Organization Name:CEDAR CREST ENT ASSOCIATES P.C.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:M.D./PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:THEODORE
Authorized Official - Middle Name:H
Authorized Official - Last Name:GAYLOR
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:610-770-9797
Mailing Address - Street 1:1251 S CEDAR CREST BLVD
Mailing Address - Street 2:SUITE 100
Mailing Address - City:ALLENTOWN
Mailing Address - State:PA
Mailing Address - Zip Code:18103-6205
Mailing Address - Country:US
Mailing Address - Phone:610-770-9797
Mailing Address - Fax:610-770-9521
Practice Address - Street 1:1251 S CEDAR CREST BLVD
Practice Address - Street 2:SUITE 100
Practice Address - City:ALLENTOWN
Practice Address - State:PA
Practice Address - Zip Code:18103-6205
Practice Address - Country:US
Practice Address - Phone:610-770-9797
Practice Address - Fax:610-770-9521
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-04-05
Last Update Date:2008-02-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PAMD022099E207KA0200X, 207YP0228X, 207YX0007X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207YX0007XAllopathic & Osteopathic PhysiciansOtolaryngologyPlastic Surgery within the Head & NeckGroup - Multi-Specialty
No207KA0200XAllopathic & Osteopathic PhysiciansAllergy & ImmunologyAllergyGroup - Multi-Specialty
No207YP0228XAllopathic & Osteopathic PhysiciansOtolaryngologyPediatric OtolaryngologyGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
PA02348200OtherCAPITAL BLUE CROSS
PA0549870OtherAETNA US HEALTHCARE
PA0549870OtherAETNA US HEALTHCARE
PAB35505Medicare UPIN
702697Medicare ID - Type Unspecified