Provider Demographics
NPI:1518979319
Name:ENT SURGERY ASSOCIATES LLC
Entity Type:Organization
Organization Name:ENT SURGERY ASSOCIATES LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:SOLE MEMBER
Authorized Official - Prefix:DR
Authorized Official - First Name:JOHN
Authorized Official - Middle Name:J
Authorized Official - Last Name:JAMESON
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:617-499-9933
Mailing Address - Street 1:725 CONCORD AVE
Mailing Address - Street 2:SUITE 2300
Mailing Address - City:CAMBRIDGE
Mailing Address - State:MA
Mailing Address - Zip Code:02138-1040
Mailing Address - Country:US
Mailing Address - Phone:617-499-9933
Mailing Address - Fax:617-499-9935
Practice Address - Street 1:725 CONCORD AVE
Practice Address - Street 2:SUITE 2300
Practice Address - City:CAMBRIDGE
Practice Address - State:MA
Practice Address - Zip Code:02138-1040
Practice Address - Country:US
Practice Address - Phone:617-499-9933
Practice Address - Fax:617-499-9935
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-08-12
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Not Answered207Y00000XAllopathic & Osteopathic PhysiciansOtolaryngologyGroup - Single Specialty
Not Answered207YS0123XAllopathic & Osteopathic PhysiciansOtolaryngologyFacial Plastic SurgeryGroup - Single Specialty