Provider Demographics
NPI:1821299090
Name:ENT ALLERGY & SINUS CENTER, INC.
Entity Type:Organization
Organization Name:ENT ALLERGY & SINUS CENTER, INC.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PHYSICIAN
Authorized Official - Prefix:DR
Authorized Official - First Name:DAVID
Authorized Official - Middle Name:M
Authorized Official - Last Name:HARTMAN
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:330-602-8833
Mailing Address - Street 1:335 OXFORD ST
Mailing Address - Street 2:SUITE A
Mailing Address - City:DOVER
Mailing Address - State:OH
Mailing Address - Zip Code:44622-1970
Mailing Address - Country:US
Mailing Address - Phone:330-602-8833
Mailing Address - Fax:330-602-8832
Practice Address - Street 1:335 OXFORD ST
Practice Address - Street 2:SUITE A
Practice Address - City:DOVER
Practice Address - State:OH
Practice Address - Zip Code:44622-1970
Practice Address - Country:US
Practice Address - Phone:330-602-8833
Practice Address - Fax:330-602-8832
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-05-29
Last Update Date:2009-09-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH35-072946207Y00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207Y00000XAllopathic & Osteopathic PhysiciansOtolaryngologyGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
OH2330776Medicaid
OH9328031Medicare PIN