Provider Demographics
NPI:1619023496
Name:MUSGROVE EAR, NOSE & THROAT, LLC, ASC
Entity Type:Organization
Organization Name:MUSGROVE EAR, NOSE & THROAT, LLC, ASC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:MEDICAL DIRECTOR
Authorized Official - Prefix:DR
Authorized Official - First Name:DAVID
Authorized Official - Middle Name:ALAN
Authorized Official - Last Name:BIANCHI
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:308-388-0500
Mailing Address - Street 1:2415 MUSGROVE RD
Mailing Address - Street 2:SUITE 201
Mailing Address - City:SILVER SPRING
Mailing Address - State:MD
Mailing Address - Zip Code:20904-5200
Mailing Address - Country:US
Mailing Address - Phone:308-388-0500
Mailing Address - Fax:
Practice Address - Street 1:2415 MUSGROVE RD
Practice Address - Street 2:SUITE 201
Practice Address - City:SILVER SPRING
Practice Address - State:MD
Practice Address - Zip Code:20904-5200
Practice Address - Country:US
Practice Address - Phone:308-388-0500
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-01-26
Last Update Date:2008-02-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MDA1239261QA1903X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QA1903XAmbulatory Health Care FacilitiesClinic/CenterAmbulatory Surgical
Provider Identifiers
StateIdentifier IDID TypeIssuer
MD314119Medicare ID - Type Unspecified