Provider Demographics
NPI:1578769261
Name:OTOLARYNGOLOGY HEAD & NECK CONSULTANTS, P.C.
Entity Type:Organization
Organization Name:OTOLARYNGOLOGY HEAD & NECK CONSULTANTS, P.C.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:RICHARD
Authorized Official - Middle Name:D
Authorized Official - Last Name:GENTILE
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:330-758-2001
Mailing Address - Street 1:6505 MARKET ST STE A103
Mailing Address - Street 2:
Mailing Address - City:YOUNGSTOWN
Mailing Address - State:OH
Mailing Address - Zip Code:44512-3400
Mailing Address - Country:US
Mailing Address - Phone:330-758-2001
Mailing Address - Fax:330-726-3577
Practice Address - Street 1:6505 MARKET ST STE A103
Practice Address - Street 2:
Practice Address - City:YOUNGSTOWN
Practice Address - State:OH
Practice Address - Zip Code:44512-3400
Practice Address - Country:US
Practice Address - Phone:330-758-2001
Practice Address - Fax:330-726-3577
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-06-21
Last Update Date:2013-09-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207YS0123XAllopathic & Osteopathic PhysiciansOtolaryngologyFacial Plastic SurgeryGroup - Single Specialty