Provider Demographics
NPI:1386842714
Name:GREYLOCK EAR NOSE AND THROAT ASSOCIATES PC
Entity Type:Organization
Organization Name:GREYLOCK EAR NOSE AND THROAT ASSOCIATES PC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:MEDICAL SECRETARY
Authorized Official - Prefix:MRS
Authorized Official - First Name:JEAN
Authorized Official - Middle Name:
Authorized Official - Last Name:HAMILTON
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:413-443-4800
Mailing Address - Street 1:510 NORTH ST
Mailing Address - Street 2:
Mailing Address - City:PITTSFIELD
Mailing Address - State:MA
Mailing Address - Zip Code:01201-4111
Mailing Address - Country:US
Mailing Address - Phone:413-443-4800
Mailing Address - Fax:413-442-9701
Practice Address - Street 1:510 NORTH ST
Practice Address - Street 2:
Practice Address - City:PITTSFIELD
Practice Address - State:MA
Practice Address - Zip Code:01201-4111
Practice Address - Country:US
Practice Address - Phone:413-443-4800
Practice Address - Fax:413-442-9701
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-07-06
Last Update Date:2013-01-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MA48706174400000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes174400000XOther Service ProvidersSpecialistGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
MA0156485Medicaid
MA10925OtherHEALTH NEW ENGLAND
MA776514OtherTUFTS
MAI22280OtherBCBS
MA04588OtherMVP
MA0482720OtherAETNA
MA000000020943OtherBOSTON MEDICAL HEALTHNET
MAM20392Medicare ID - Type Unspecified
MA0156485Medicaid