Provider Demographics
NPI:1184071854
Name:BOSCO E NORONHA MD,PC
Entity type:Organization
Organization Name:BOSCO E NORONHA MD,PC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:EMPLOYEE
Authorized Official - Prefix:
Authorized Official - First Name:TRACIE
Authorized Official - Middle Name:
Authorized Official - Last Name:WHETSEL
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:724-549-5764
Mailing Address - Street 1:1265 WAYNE AVE
Mailing Address - Street 2:SUITE 100
Mailing Address - City:INDIANA
Mailing Address - State:PA
Mailing Address - Zip Code:15701-3501
Mailing Address - Country:US
Mailing Address - Phone:724-349-5440
Mailing Address - Fax:724-349-7445
Practice Address - Street 1:1265 WAYNE AVE
Practice Address - Street 2:SUITE 100
Practice Address - City:INDIANA
Practice Address - State:PA
Practice Address - Zip Code:15701-3501
Practice Address - Country:US
Practice Address - Phone:724-349-5440
Practice Address - Fax:724-349-7445
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2016-05-23
Last Update Date:2016-11-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PAMD072191L207Y00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207Y00000XAllopathic & Osteopathic PhysiciansOtolaryngologyGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
PAMD072191LOtherMEDICAL LICENSE