Provider Demographics
NPI:1295786465
Name:COLDEN EAR NOSE THROAT & ALLERGY LLC
Entity type:Organization
Organization Name:COLDEN EAR NOSE THROAT & ALLERGY LLC
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:PRACTICE MGR.
Authorized Official - Prefix:
Authorized Official - First Name:CRISSY
Authorized Official - Middle Name:L
Authorized Official - Last Name:OLSON
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:978-947-1550
Mailing Address - Street 1:1 WALLACE BASHAW JR. WAY
Mailing Address - Street 2:SUITE 3002
Mailing Address - City:NEWBURYPORT
Mailing Address - State:MA
Mailing Address - Zip Code:01950-3875
Mailing Address - Country:US
Mailing Address - Phone:978-997-1550
Mailing Address - Fax:978-499-8200
Practice Address - Street 1:1 WALLACE BASHAW JR. WAY
Practice Address - Street 2:SUITE 3002
Practice Address - City:NEWBURYPORT
Practice Address - State:MA
Practice Address - Zip Code:01950-3875
Practice Address - Country:US
Practice Address - Phone:978-997-1550
Practice Address - Fax:978-499-8200
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-05-13
Last Update Date:2025-02-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207Y00000XAllopathic & Osteopathic PhysiciansOtolaryngologyGroup - Multi-Specialty
No207YX0905XAllopathic & Osteopathic PhysiciansOtolaryngologyOtolaryngology/Facial Plastic SurgeryGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
MADG8781OtherRAILROAD MEDICARE
MADG8781OtherRAILROAD MEDICARE