Provider Demographics
NPI:1013977552
Name:THE OTOLARYNGOLOGY GROUP, P.C.
Entity type:Organization
Organization Name:THE OTOLARYNGOLOGY GROUP, P.C.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:DANIEL
Authorized Official - Middle Name:
Authorized Official - Last Name:VOGEL
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:978-371-1400
Mailing Address - Street 1:PO BOX 1807
Mailing Address - Street 2:
Mailing Address - City:MERRIMACK
Mailing Address - State:NH
Mailing Address - Zip Code:03054-1807
Mailing Address - Country:US
Mailing Address - Phone:603-673-9411
Mailing Address - Fax:603-673-9899
Practice Address - Street 1:111 OLD ROAD TO 9 ACRE COR
Practice Address - Street 2:SUITE 490
Practice Address - City:CONCORD
Practice Address - State:MA
Practice Address - Zip Code:01742-4141
Practice Address - Country:US
Practice Address - Phone:978-371-1400
Practice Address - Fax:978-371-0246
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-03-27
Last Update Date:2007-12-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207Y00000XAllopathic & Osteopathic PhysiciansOtolaryngologyGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
MA0012238OtherNEIGHBORHOOD HEALTH
MA1534327OtherUNITED MINE WORKERS OF AM
MA95846OtherAETNA
MAM15183OtherBLUE CROSS BLUE SHIELD
MA9442OtherHEALTHSOURCE
MA600537OtherTUFTS
MACL3887OtherRAILROAD MEDICARE
MA9763171Medicaid
MA0012238OtherNEIGHBORHOOD HEALTH