Provider Demographics
NPI:1164534319
Name:EAR NOSE AND THROAT ASSOCIATES OF JOHNSTOWN, INC.
Entity Type:Organization
Organization Name:EAR NOSE AND THROAT ASSOCIATES OF JOHNSTOWN, INC.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PHYSICIAN
Authorized Official - Prefix:
Authorized Official - First Name:DAVID
Authorized Official - Middle Name:R
Authorized Official - Last Name:ROGERSON
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:814-262-3953
Mailing Address - Street 1:348 BUDFIELD STREET
Mailing Address - Street 2:
Mailing Address - City:JOHNSTOWN
Mailing Address - State:PA
Mailing Address - Zip Code:15904-3214
Mailing Address - Country:US
Mailing Address - Phone:814-262-3950
Mailing Address - Fax:814-262-3990
Practice Address - Street 1:348 BUDFIELD STREET
Practice Address - Street 2:
Practice Address - City:JOHNSTOWN
Practice Address - State:PA
Practice Address - Zip Code:15904-3214
Practice Address - Country:US
Practice Address - Phone:814-262-3950
Practice Address - Fax:814-262-3990
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-08-31
Last Update Date:2009-06-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207Y00000XAllopathic & Osteopathic PhysiciansOtolaryngologyGroup - Multi-Specialty
No207YX0602XAllopathic & Osteopathic PhysiciansOtolaryngologyOtolaryngic AllergyGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
PA765442Medicare PIN