Provider Demographics
NPI:1518044395
Name:EAR,NOSE AND THROAT ASSOCIATES OF SOUTHEASTERN CONNECTICUT, P.C.
Entity Type:Organization
Organization Name:EAR,NOSE AND THROAT ASSOCIATES OF SOUTHEASTERN CONNECTICUT, P.C.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRACTICE MANAGER
Authorized Official - Prefix:
Authorized Official - First Name:CAROLYN
Authorized Official - Middle Name:A
Authorized Official - Last Name:HOWELL
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:860-536-3078
Mailing Address - Street 1:201 BOSTON POST RD
Mailing Address - Street 2:
Mailing Address - City:WATERFORD
Mailing Address - State:CT
Mailing Address - Zip Code:06385-2805
Mailing Address - Country:US
Mailing Address - Phone:860-442-0407
Mailing Address - Fax:
Practice Address - Street 1:201 BOSTON POST RD
Practice Address - Street 2:
Practice Address - City:WATERFORD
Practice Address - State:CT
Practice Address - Zip Code:06385-2805
Practice Address - Country:US
Practice Address - Phone:860-442-0407
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-11-01
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207Y00000XAllopathic & Osteopathic PhysiciansOtolaryngologyGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
=========OtherTAX ID#
CTC00207Medicare ID - Type UnspecifiedGROUP