Provider Demographics
NPI:1710097159
Name:EAR NOSE & THROAT AND HEARING CENTER OF EASTERN MASSACHUSETTS PC
Entity Type:Organization
Organization Name:EAR NOSE & THROAT AND HEARING CENTER OF EASTERN MASSACHUSETTS PC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:VICTOR
Authorized Official - Middle Name:E
Authorized Official - Last Name:CALCATERRA
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:508-626-8956
Mailing Address - Street 1:1342 BELMONT ST
Mailing Address - Street 2:SUITE 205
Mailing Address - City:BROCKTON
Mailing Address - State:MA
Mailing Address - Zip Code:02301-4436
Mailing Address - Country:US
Mailing Address - Phone:508-626-8956
Mailing Address - Fax:508-875-4103
Practice Address - Street 1:61 LINCOLN ST
Practice Address - Street 2:SUITE 109
Practice Address - City:FRAMINGHAM
Practice Address - State:MA
Practice Address - Zip Code:01702-8264
Practice Address - Country:US
Practice Address - Phone:508-626-8956
Practice Address - Fax:508-875-4103
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-08-30
Last Update Date:2008-07-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207Y00000XAllopathic & Osteopathic PhysiciansOtolaryngologyGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
MA9701486Medicaid
MAM20834Medicare ID - Type Unspecified