Provider Demographics
NPI:1336110261
Name:POTTSVILLE ENT, LLC
Entity Type:Organization
Organization Name:POTTSVILLE ENT, LLC
Other - Org Name:SCHUYLKILL OTOLARYNGOLOGY ASSO, INC.
Other - Org Type:Former Legal Business Name
Authorized Official - Title/Position:OWNER/PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:MOHAMMAD
Authorized Official - Middle Name:M
Authorized Official - Last Name:AKBAR
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:570-622-5751
Mailing Address - Street 1:26 S. CENTRE ST.
Mailing Address - Street 2:
Mailing Address - City:POTTSVILLE
Mailing Address - State:PA
Mailing Address - Zip Code:17901-3075
Mailing Address - Country:US
Mailing Address - Phone:570-622-5751
Mailing Address - Fax:570-628-0841
Practice Address - Street 1:26 S. CENTRE ST.
Practice Address - Street 2:
Practice Address - City:POTTSVILLE
Practice Address - State:PA
Practice Address - Zip Code:17901-3075
Practice Address - Country:US
Practice Address - Phone:570-622-5751
Practice Address - Fax:570-628-0841
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-01-30
Last Update Date:2014-08-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
207Y00000X
PA207YX0602X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207YX0602XAllopathic & Osteopathic PhysiciansOtolaryngologyOtolaryngic AllergyGroup - Multi-Specialty
No207Y00000XAllopathic & Osteopathic PhysiciansOtolaryngologyGroup - Multi-Specialty