Provider Demographics
NPI:1477554327
Name:CAPITOL EAR, NOSE & THROAT
Entity Type:Organization
Organization Name:CAPITOL EAR, NOSE & THROAT
Other - Org Name:CAPITOL ENT
Other - Org Type:Other Name
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:MARK
Authorized Official - Middle Name:
Authorized Official - Last Name:BROWN
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:919-787-1374
Mailing Address - Street 1:4600 LAKE BOONE TRAIL
Mailing Address - Street 2:SUITE 100
Mailing Address - City:RALEIGH
Mailing Address - State:NC
Mailing Address - Zip Code:27607-7529
Mailing Address - Country:US
Mailing Address - Phone:919-787-1374
Mailing Address - Fax:919-571-8135
Practice Address - Street 1:4600 LAKE BOONE TRAIL
Practice Address - Street 2:SUITE 100
Practice Address - City:RALEIGH
Practice Address - State:NC
Practice Address - Zip Code:27607-7529
Practice Address - Country:US
Practice Address - Phone:919-787-1374
Practice Address - Fax:919-571-8135
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2005-08-02
Last Update Date:2012-08-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC207YX0905X, 231H00000X, 235Z00000X, 332S00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207YX0905XAllopathic & Osteopathic PhysiciansOtolaryngologyOtolaryngology/Facial Plastic SurgeryGroup - Multi-Specialty
No231H00000XSpeech, Language and Hearing Service ProvidersAudiologistGroup - Multi-Specialty
No235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language PathologistGroup - Multi-Specialty
No332S00000XSuppliersHearing Aid EquipmentGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
NCE94075Medicare UPIN
NC2076789Medicare PIN
NCD92873Medicare UPIN
NCC82007Medicare UPIN
NCC87162Medicare UPIN
NCC89417Medicare UPIN
NCF24896Medicare UPIN