Healthcare Provider Details

I. General information

NPI: 1447657564
Provider Name (Legal Business Name): NORTH SHORE EAR, NOSE & THROAT ASSOCIATES
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 12/04/2014
Last Update Date: 12/04/2014
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

104 ENDICOTT ST SUITE 100
DANVERS MA
01923-3623
US

IV. Provider business mailing address

104 ENDICOTT ST SUITE 100
DANVERS MA
01923-3623
US

V. Phone/Fax

Practice location:
  • Phone: 978-745-6601
  • Fax:
Mailing address:
  • Phone: 978-745-6601
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207Y00000X
TaxonomyOtolaryngology Physician
License Number208512
License Number StateMA

VIII. Authorized Official

Name: DR. RICHARD MUGGE
Title or Position: TREASURER
Credential: M.D.
Phone: 978-745-6601