Provider Demographics
NPI:1982862991
Name:EAR NOSE THROAT SPECILIST PORTSMOUTH INC
Entity Type:Organization
Organization Name:EAR NOSE THROAT SPECILIST PORTSMOUTH INC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:MANAGER
Authorized Official - Prefix:MS
Authorized Official - First Name:NIKIA
Authorized Official - Middle Name:
Authorized Official - Last Name:COBB
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:757-483-1700
Mailing Address - Street 1:4053 TAYLOR RD
Mailing Address - Street 2:SUITE M
Mailing Address - City:CHESAPEAKE
Mailing Address - State:VA
Mailing Address - Zip Code:23321-5537
Mailing Address - Country:US
Mailing Address - Phone:757-483-1700
Mailing Address - Fax:757-483-3973
Practice Address - Street 1:4053 TAYLOR RD
Practice Address - Street 2:SUITE M
Practice Address - City:CHESAPEAKE
Practice Address - State:VA
Practice Address - Zip Code:23321-5537
Practice Address - Country:US
Practice Address - Phone:757-483-1700
Practice Address - Fax:757-483-3973
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2008-05-27
Last Update Date:2008-06-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207Y00000XAllopathic & Osteopathic PhysiciansOtolaryngologyGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
VAB05784Medicare UPIN