Provider Demographics
NPI:1477589117
Name:ANNAPOLIS EAR NOSE THROAT & ALLERGY ASSOCIATES P A
Entity Type:Organization
Organization Name:ANNAPOLIS EAR NOSE THROAT & ALLERGY ASSOCIATES P A
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PHYSICIAN
Authorized Official - Prefix:MR
Authorized Official - First Name:JOYDEEP
Authorized Official - Middle Name:
Authorized Official - Last Name:SOM
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:410-841-5279
Mailing Address - Street 1:2002 MEDICAL PARKWAY
Mailing Address - Street 2:STE 230
Mailing Address - City:ANNAPOLIS
Mailing Address - State:MD
Mailing Address - Zip Code:21401-3046
Mailing Address - Country:US
Mailing Address - Phone:410-266-3900
Mailing Address - Fax:410-266-9245
Practice Address - Street 1:2002 MEDICAL PARKWAY
Practice Address - Street 2:STE 230
Practice Address - City:ANNAPOLIS
Practice Address - State:MD
Practice Address - Zip Code:21401-3046
Practice Address - Country:US
Practice Address - Phone:410-266-3900
Practice Address - Fax:410-266-9245
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-06-24
Last Update Date:2013-06-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MDD0055675207Y00000X
MDD0039443207Y00000X
MDD0055715207Y00000X
MDD0066415207Y00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207Y00000XAllopathic & Osteopathic PhysiciansOtolaryngologyGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
MD699220000Medicaid
H13688Medicare UPIN
MD699220000Medicaid
F47439Medicare UPIN
MD870LMedicare ID - Type Unspecified