Provider Demographics
NPI:1508065657
Name:EAR,NOSE & THROAT OF GREATER HARTFORD, P.C.
Entity Type:Organization
Organization Name:EAR,NOSE & THROAT OF GREATER HARTFORD, P.C.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:RONALD
Authorized Official - Middle Name:J
Authorized Official - Last Name:SAXON
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:860-243-8997
Mailing Address - Street 1:4 NORTHWESTERN DR
Mailing Address - Street 2:SUITE 300
Mailing Address - City:BLOOMFIELD
Mailing Address - State:CT
Mailing Address - Zip Code:06002-3444
Mailing Address - Country:US
Mailing Address - Phone:860-243-8997
Mailing Address - Fax:860-769-6803
Practice Address - Street 1:4 NORTHWESTERN DR
Practice Address - Street 2:SUITE 300
Practice Address - City:BLOOMFIELD
Practice Address - State:CT
Practice Address - Zip Code:06002-3444
Practice Address - Country:US
Practice Address - Phone:860-243-8997
Practice Address - Fax:860-769-6803
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-07-17
Last Update Date:2009-12-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207Y00000XAllopathic & Osteopathic PhysiciansOtolaryngologyGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
CT004394772Medicaid
CTC03148Medicare PIN