Provider Demographics
NPI:1770524175
Name:VERNOSE & MCGRATH OTOLARYNGOLOGY ASSOCIATES
Entity type:Organization
Organization Name:VERNOSE & MCGRATH OTOLARYNGOLOGY ASSOCIATES
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:GERARD
Authorized Official - Middle Name:V
Authorized Official - Last Name:VERNOSE
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:215-465-8800
Mailing Address - Street 1:1841 SOUTH BROAD STREET
Mailing Address - Street 2:
Mailing Address - City:PHILADELPHIA
Mailing Address - State:PA
Mailing Address - Zip Code:19148
Mailing Address - Country:US
Mailing Address - Phone:215-465-8800
Mailing Address - Fax:267-639-9971
Practice Address - Street 1:1841 SOUTH BROAD STREET
Practice Address - Street 2:
Practice Address - City:PHILADELPHIA
Practice Address - State:PA
Practice Address - Zip Code:19148
Practice Address - Country:US
Practice Address - Phone:215-465-8800
Practice Address - Fax:267-639-9971
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-06-09
Last Update Date:2022-07-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PAMD015406E207YX0007X
PAOS007444L207YX0007X
207Y00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207Y00000XAllopathic & Osteopathic PhysiciansOtolaryngologyGroup - Single Specialty
No207YX0007XAllopathic & Osteopathic PhysiciansOtolaryngologyPlastic Surgery within the Head & NeckGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
PAB36970Medicare UPIN
PA673181Medicare UPIN
PAG14573Medicare UPIN