Provider Demographics
NPI:1497796411
Name:CAMBRIDGE ENT AND ALLERGY CLINIC, INC.
Entity Type:Organization
Organization Name:CAMBRIDGE ENT AND ALLERGY CLINIC, INC.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT, CEO
Authorized Official - Prefix:DR
Authorized Official - First Name:JOHN
Authorized Official - Middle Name:BERNARD
Authorized Official - Last Name:GHOLL
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:740-439-3800
Mailing Address - Street 1:813 STEUBENVILLE AVE
Mailing Address - Street 2:
Mailing Address - City:CAMBRIDGE
Mailing Address - State:OH
Mailing Address - Zip Code:43725
Mailing Address - Country:US
Mailing Address - Phone:740-439-3800
Mailing Address - Fax:
Practice Address - Street 1:813 STEUBENVILLE AVE
Practice Address - Street 2:
Practice Address - City:CAMBRIDGE
Practice Address - State:OH
Practice Address - Zip Code:43725-2383
Practice Address - Country:US
Practice Address - Phone:740-439-3800
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-06-09
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH35-08-2261-G261QM2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QM2500XAmbulatory Health Care FacilitiesClinic/CenterMedical Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
OH2387948Medicaid
OHGH4107832Medicare ID - Type Unspecified
OHE12763Medicare UPIN