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NPI Code Detail

MEDICARE: CRAWFORD COUNTY ENT PC

MEDICARE: CRAWFORD COUNTY ENT 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
1207Y00000XOtolaryngology PhysicianMD046736LPA

Medicare Identifiers

# Provider Identifier Provider Identifier Type Provider Identifier State Provider Identifier Issuer
2079117OTHERPAMEDICARE PTAN

Other Identifiers

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

General Provider Information

NPI Number : 1730223801
Entity Type Code : Organization
Provider Name (Legal Business Name) : CRAWFORD COUNTY ENT PC
Provider Business Mailing Address
First Line : 505 POPLAR ST
Second Line :
City : MEADVILLE
State : PA
Zip : 16335-3057
Country : US
Telephone Number : 814-373-3070
Fax Number : 814-373-3074
Provider Business Practice Location Address
First Line : 505 POPLAR ST
Second Line :
City : MEADVILLE
State : PA
Zip : 16335-3057
Country : US
Telephone Number : 814-373-3070
Fax Number : 814-373-3074
Authorized Official
Title or Position : OFFICE MANAGER
Name : MRS. ANGELA MOOK
Credential :
Telephone Number : 814-373-3070
Provider Enumeration Date : 02/20/2007
Last Update Date : 11/30/2022

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Directions to “CRAWFORD COUNTY ENT PC ” Practice Location

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