Provider Demographics
NPI:1689690513
Name:MARYLAND ENT CENTER, LLC
Entity Type:Organization
Organization Name:MARYLAND ENT CENTER, LLC
Other - Org Name:TOWSON EAR NOSE & THROAT, LLC
Other - Org Type:Former Legal Business Name
Authorized Official - Title/Position:PARTNER
Authorized Official - Prefix:DR
Authorized Official - First Name:ALAN
Authorized Official - Middle Name:H
Authorized Official - Last Name:SHIKANI
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:410-554-4455
Mailing Address - Street 1:200 E 33RD ST
Mailing Address - Street 2:33RD ST PROF BUILDING, SUITE 631
Mailing Address - City:BALTIMORE
Mailing Address - State:MD
Mailing Address - Zip Code:21218-3322
Mailing Address - Country:US
Mailing Address - Phone:410-554-4455
Mailing Address - Fax:410-554-2171
Practice Address - Street 1:200 E 33RD ST
Practice Address - Street 2:33RD ST PROF BUILDING, SUITE 631
Practice Address - City:BALTIMORE
Practice Address - State:MD
Practice Address - Zip Code:21218-3322
Practice Address - Country:US
Practice Address - Phone:410-554-4455
Practice Address - Fax:410-554-2171
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-07-14
Last Update Date:2014-11-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207Y00000XAllopathic & Osteopathic PhysiciansOtolaryngologyGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
MD563200500Medicaid
MD080MMedicare ID - Type Unspecified
MD563200500Medicaid