Provider Demographics
NPI:1225152663
Name:ASSOCIATES IN OTOLARYNGOLOGY HEAD AND NECK SURGERY PC
Entity Type:Organization
Organization Name:ASSOCIATES IN OTOLARYNGOLOGY HEAD AND NECK SURGERY PC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:ANDREA
Authorized Official - Middle Name:
Authorized Official - Last Name:CHIARAMONTE
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:508-757-0330
Mailing Address - Street 1:100 MLK JR BLVD STE 4
Mailing Address - Street 2:
Mailing Address - City:WORCESTER
Mailing Address - State:MA
Mailing Address - Zip Code:01608-1209
Mailing Address - Country:US
Mailing Address - Phone:508-757-0330
Mailing Address - Fax:508-754-9426
Practice Address - Street 1:100 MLK JR BLVD STE 4
Practice Address - Street 2:
Practice Address - City:WORCESTER
Practice Address - State:MA
Practice Address - Zip Code:01608-1209
Practice Address - Country:US
Practice Address - Phone:508-757-0330
Practice Address - Fax:508-752-9850
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-03-19
Last Update Date:2018-03-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207Y00000XAllopathic & Osteopathic PhysiciansOtolaryngologyGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
MA9750495Medicaid
MAASM14420OtherBLUE CROSS
MA9750495Medicaid