Provider Demographics
NPI:1689768616
Name:METROWEST EAR NOSE & THROAT ASSOC.
Entity Type:Organization
Organization Name:METROWEST EAR NOSE & THROAT ASSOC.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:CARL
Authorized Official - Middle Name:
Authorized Official - Last Name:LIEBERMAN
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:508-875-6124
Mailing Address - Street 1:61 LINCOLN ST
Mailing Address - Street 2:SUITE 207
Mailing Address - City:FRAMINGHAM
Mailing Address - State:MA
Mailing Address - Zip Code:01702-8264
Mailing Address - Country:US
Mailing Address - Phone:508-875-6124
Mailing Address - Fax:
Practice Address - Street 1:61 LINCOLN ST
Practice Address - Street 2:SUITE 207
Practice Address - City:FRAMINGHAM
Practice Address - State:MA
Practice Address - Zip Code:01702-8264
Practice Address - Country:US
Practice Address - Phone:508-875-6124
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-10-03
Last Update Date:2015-04-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes174400000XOther Service ProvidersSpecialistGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
MAM15610OtherBLUE CROSS BLUE SHEILD
MA9700897Medicaid
MAM15610OtherBLUECROSSBLUESHEILD
MA0008841OtherNEIGHBORHOOD HEALTH
MA23496OtherFALLON SELECT/DIRECT
MA600224OtherTUFTS
MAM15610Medicare UPIN