Provider Demographics
NPI:1568492858
Name:EAR, NOSE, AND THROAT ASSOCIATES OF NORTHWESTERN PENNSYLVANIA
Entity Type:Organization
Organization Name:EAR, NOSE, AND THROAT ASSOCIATES OF NORTHWESTERN PENNSYLVANIA
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:MARC
Authorized Official - Middle Name:D
Authorized Official - Last Name:MASLOV
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:814-677-6381
Mailing Address - Street 1:PO BOX 545
Mailing Address - Street 2:
Mailing Address - City:SENECA
Mailing Address - State:PA
Mailing Address - Zip Code:16346-0545
Mailing Address - Country:US
Mailing Address - Phone:814-677-6381
Mailing Address - Fax:814-677-6384
Practice Address - Street 1:TWO PARK WAY
Practice Address - Street 2:
Practice Address - City:SENECA
Practice Address - State:PA
Practice Address - Zip Code:16346
Practice Address - Country:US
Practice Address - Phone:814-677-6381
Practice Address - Fax:814-677-6384
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-07-03
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PAMD045086E207Y00000X
PAAT000043L231H00000X
PAAT000767L231H00000X
PAAT001170L231H00000X
PA025111291U00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Not Answered207Y00000XAllopathic & Osteopathic PhysiciansOtolaryngologyGroup - Multi-Specialty
Not Answered231H00000XSpeech, Language and Hearing Service ProvidersAudiologistGroup - Multi-Specialty
Not Answered291U00000XLaboratoriesClinical Medical LaboratoryGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
PA100742736 0009Medicaid
PA100742736 0002Medicaid
PA725508OtherHIGHMARK GROUP #
PA997088OtherHIGHMARK GROUP AUDIOLOGY
PAE36813Medicare UPIN
PA100742736 0002Medicaid
PA725508Medicare ID - Type UnspecifiedGROUP MEDICARE #
PAP92046Medicare UPIN
PA997088OtherHIGHMARK GROUP AUDIOLOGY