Provider Demographics
NPI:1619024130
Name:ENT AND ALLERGY INC
Entity Type:Organization
Organization Name:ENT AND ALLERGY INC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER AND PROVIDER
Authorized Official - Prefix:DR
Authorized Official - First Name:CHARLES
Authorized Official - Middle Name:S
Authorized Official - Last Name:FABER
Authorized Official - Suffix:
Authorized Official - Credentials:DO
Authorized Official - Phone:401-785-0976
Mailing Address - Street 1:3520 POST RD
Mailing Address - Street 2:
Mailing Address - City:WARWICK
Mailing Address - State:RI
Mailing Address - Zip Code:02886-7140
Mailing Address - Country:US
Mailing Address - Phone:401-921-5800
Mailing Address - Fax:401-921-2891
Practice Address - Street 1:3520 POST RD
Practice Address - Street 2:
Practice Address - City:WARWICK
Practice Address - State:RI
Practice Address - Zip Code:02886-7140
Practice Address - Country:US
Practice Address - Phone:401-921-5800
Practice Address - Fax:401-921-2891
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-01-05
Last Update Date:2022-07-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
RI207Y00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207Y00000XAllopathic & Osteopathic PhysiciansOtolaryngologyGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
RI0000002640OtherBLUESHIELD
RI9002640Medicaid
RI9002640Medicaid
RI049002640Medicare ID - Type Unspecified