Provider Demographics
NPI:1326618448
Name:NORTH BAY ENT & AUDIOLOGY GROUP LLC
Entity Type:Organization
Organization Name:NORTH BAY ENT & AUDIOLOGY GROUP LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CREDENTIALING COORDINATOR
Authorized Official - Prefix:
Authorized Official - First Name:JANELLE
Authorized Official - Middle Name:
Authorized Official - Last Name:ADOLPH
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:410-688-9753
Mailing Address - Street 1:520 UPPER CHESAPEAKE DR STE 206
Mailing Address - Street 2:
Mailing Address - City:BEL AIR
Mailing Address - State:MD
Mailing Address - Zip Code:21014-4360
Mailing Address - Country:US
Mailing Address - Phone:410-879-9100
Mailing Address - Fax:410-638-0408
Practice Address - Street 1:520 UPPER CHESAPEAKE DR STE 206
Practice Address - Street 2:
Practice Address - City:BEL AIR
Practice Address - State:MD
Practice Address - Zip Code:21014-4360
Practice Address - Country:US
Practice Address - Phone:410-879-9100
Practice Address - Fax:410-638-0408
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2021-06-30
Last Update Date:2023-11-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207Y00000XAllopathic & Osteopathic PhysiciansOtolaryngologyGroup - Single Specialty
No231H00000XSpeech, Language and Hearing Service ProvidersAudiologistGroup - Single Specialty
No237600000XSpeech, Language and Hearing Service ProvidersAudiologist-Hearing Aid FitterGroup - Single Specialty