MEDICARE: CENTRAL EAR NOSE & THROAT ASSOC PC

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	207YS0123X	Facial Plastic Surgery Physician	MA35665	MA

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number	:	1689668915
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	CENTRAL EAR NOSE & THROAT ASSOC PC

Provider Business Mailing Address
First Line	:	295 LINCOLN ST
Second Line	:	SUITE 101
City	:	WORCESTER
State	:	MA
Zip	:	01605-3639
Country	:	US
Telephone Number	:	508-755-3161
Fax Number	:

Provider Business Practice Location Address
First Line	:	295 LINCOLN ST
Second Line	:	SUITE 101
City	:	WORCESTER
State	:	MA
Zip	:	01605-3639
Country	:	US
Telephone Number	:	508-755-3161
Fax Number	:

Authorized Official
Title or Position	:	PRESIDENT / CO-OWNER
Name	:	DR. JEFFREY R FINE
Credential	:
Telephone Number	:	508-755-3161

Provider Enumeration Date	:	09/01/2005
Last Update Date	:	08/22/2020

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