Provider Demographics
NPI:1780830620
Name:MAIN LINE EAR, NOSE & THROAT, PC
Entity Type:Organization
Organization Name:MAIN LINE EAR, NOSE & THROAT, PC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PHYSICIAN OWNER
Authorized Official - Prefix:
Authorized Official - First Name:CHRISTOPHER
Authorized Official - Middle Name:RANDALL
Authorized Official - Last Name:HOVE
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:610-647-3727
Mailing Address - Street 1:17 INDUSTRIAL BLVD
Mailing Address - Street 2:SUITE 102
Mailing Address - City:PAOLI
Mailing Address - State:PA
Mailing Address - Zip Code:19301-1607
Mailing Address - Country:US
Mailing Address - Phone:610-647-3727
Mailing Address - Fax:610-647-4969
Practice Address - Street 1:17 INDUSTRIAL BLVD
Practice Address - Street 2:SUITE 102
Practice Address - City:PAOLI
Practice Address - State:PA
Practice Address - Zip Code:19301-1607
Practice Address - Country:US
Practice Address - Phone:610-647-3727
Practice Address - Fax:610-647-4969
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2008-08-12
Last Update Date:2015-03-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PAMD431700207YS0123X
PA231H00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207YS0123XAllopathic & Osteopathic PhysiciansOtolaryngologyFacial Plastic SurgeryGroup - Multi-Specialty
No231H00000XSpeech, Language and Hearing Service ProvidersAudiologistGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
PA102498645-0001Medicaid
PA148772Medicare PIN