Provider Demographics
NPI:1619437654
Name:PROVIDENCE EAR NOSE & THROAT ASSOCIATES INC
Entity Type:Organization
Organization Name:PROVIDENCE EAR NOSE & THROAT ASSOCIATES INC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:AUTHORIZED OFFICIAL
Authorized Official - Prefix:
Authorized Official - First Name:JOHN
Authorized Official - Middle Name:M
Authorized Official - Last Name:FEEHERY
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:610-874-5366
Mailing Address - Street 1:2112 PROVIDENCE AVE
Mailing Address - Street 2:
Mailing Address - City:CHESTER
Mailing Address - State:PA
Mailing Address - Zip Code:19013-5507
Mailing Address - Country:US
Mailing Address - Phone:610-874-5366
Mailing Address - Fax:610-874-8448
Practice Address - Street 1:500 EVERGREEN DR STE 18
Practice Address - Street 2:
Practice Address - City:GLEN MILLS
Practice Address - State:PA
Practice Address - Zip Code:19342-1032
Practice Address - Country:US
Practice Address - Phone:610-495-3495
Practice Address - Fax:610-459-3237
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2019-03-25
Last Update Date:2019-03-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207Y00000XAllopathic & Osteopathic PhysiciansOtolaryngologyGroup - Single Specialty