Provider Demographics
NPI:1164517314
Name:EAR NOSE AND THROAT AND FACIAL PLASTIC SURGERY CENTER OF FREDERICK
Entity Type:Organization
Organization Name:EAR NOSE AND THROAT AND FACIAL PLASTIC SURGERY CENTER OF FREDERICK
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:MANAGING PHYSICIAN
Authorized Official - Prefix:
Authorized Official - First Name:CALEB
Authorized Official - Middle Name:
Authorized Official - Last Name:MASSEY
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:540-371-1226
Mailing Address - Street 1:1708 FALL HILL AVE
Mailing Address - Street 2:SUITE 100
Mailing Address - City:FREDERICKSBURG
Mailing Address - State:VA
Mailing Address - Zip Code:22401-3511
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:1708 FALL HILL AVE
Practice Address - Street 2:SUITE 100
Practice Address - City:FREDERICKSBURG
Practice Address - State:VA
Practice Address - Zip Code:22401-3511
Practice Address - Country:US
Practice Address - Phone:540-371-1226
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-10-04
Last Update Date:2008-06-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207Y00000XAllopathic & Osteopathic PhysiciansOtolaryngologyGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
VACD7365OtherMEDICARE RAILROAD