Provider Demographics
NPI:1184118564
Name:MASSACHUSETTS ENT CONSULTANTS LLC
Entity type:Organization
Organization Name:MASSACHUSETTS ENT CONSULTANTS LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:MANAGER
Authorized Official - Prefix:
Authorized Official - First Name:THOMAS
Authorized Official - Middle Name:H
Authorized Official - Last Name:COSTELLO
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:781-937-3001
Mailing Address - Street 1:100 SYLVAN RD STE 750
Mailing Address - Street 2:
Mailing Address - City:WOBURN
Mailing Address - State:MA
Mailing Address - Zip Code:01801-1852
Mailing Address - Country:US
Mailing Address - Phone:781-937-3001
Mailing Address - Fax:781-937-3070
Practice Address - Street 1:100 SYLVAN RD STE 750
Practice Address - Street 2:
Practice Address - City:WOBURN
Practice Address - State:MA
Practice Address - Zip Code:01801-1852
Practice Address - Country:US
Practice Address - Phone:781-937-3001
Practice Address - Fax:781-937-3070
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:EAR, NOSE & THROAT CONSULTANTS, INC
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2018-06-19
Last Update Date:2018-06-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MA223562207Y00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207Y00000XAllopathic & Osteopathic PhysiciansOtolaryngologyGroup - Single Specialty