Provider Demographics
NPI:1710089867
Name:RECALDE EAR NOSE & THROAT CLINIC PC
Entity Type:Organization
Organization Name:RECALDE EAR NOSE & THROAT CLINIC PC
Other - Org Name:CARLOS M RECALDE MD
Other - Org Type:Other Name
Authorized Official - Title/Position:PHYSICIAN OTOLARYNGOLOGIST
Authorized Official - Prefix:
Authorized Official - First Name:CARLOS
Authorized Official - Middle Name:M
Authorized Official - Last Name:RECALDE
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:717-248-9694
Mailing Address - Street 1:307 FOURTH STREET
Mailing Address - Street 2:PLEASANT ACRES
Mailing Address - City:LEWISTOWN
Mailing Address - State:PA
Mailing Address - Zip Code:17044-1316
Mailing Address - Country:US
Mailing Address - Phone:717-248-9694
Mailing Address - Fax:717-248-5806
Practice Address - Street 1:307 FOURTH STREET
Practice Address - Street 2:PLEASANT ACRES
Practice Address - City:LEWISTOWN
Practice Address - State:PA
Practice Address - Zip Code:17044-1316
Practice Address - Country:US
Practice Address - Phone:717-248-9694
Practice Address - Fax:717-248-5806
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-09-01
Last Update Date:2010-10-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PAMD034182E207Y00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207Y00000XAllopathic & Osteopathic PhysiciansOtolaryngologyGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
PA0011911300001Medicaid
665120Medicare ID - Type Unspecified
PA0011911300001Medicaid