Provider Demographics
NPI:1134564073
Name:EAR, NOSE, THROAT & ALLERGY CONSULTANTS, PC
Entity type:Organization
Organization Name:EAR, NOSE, THROAT & ALLERGY CONSULTANTS, PC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER/PROVIDER
Authorized Official - Prefix:
Authorized Official - First Name:LETICIA
Authorized Official - Middle Name:IBARRA
Authorized Official - Last Name:PELTZER
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:276-698-8099
Mailing Address - Street 1:26208 LEE HIGHWAY
Mailing Address - Street 2:
Mailing Address - City:ABINGDON
Mailing Address - State:VA
Mailing Address - Zip Code:24211-7504
Mailing Address - Country:US
Mailing Address - Phone:276-451-3044
Mailing Address - Fax:276-451-3045
Practice Address - Street 1:26208 LEE HIGHWAY
Practice Address - Street 2:
Practice Address - City:ABINGDON
Practice Address - State:VA
Practice Address - Zip Code:24211-7504
Practice Address - Country:US
Practice Address - Phone:276-451-3044
Practice Address - Fax:276-451-3045
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2013-05-06
Last Update Date:2014-11-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA0101238767207Y00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207Y00000XAllopathic & Osteopathic PhysiciansOtolaryngologyGroup - Single Specialty