Healthcare Provider Details

I. General information

NPI: 1669144994
Provider Name (Legal Business Name): NORTH SHORE EAR, NOSE AND THROAT ASSOCIATES
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 10/05/2021
Last Update Date: 10/05/2021
Certification Date: 09/20/2021
Deactivation Date:
Reactivation Date:

III. Provider practice location address

104 ENDICOTT ST STE 100
DANVERS MA
01923-0009
US

IV. Provider business mailing address

104 ENDICOTT ST STE 100
DANVERS MA
01923-0009
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 Number
License Number State

VIII. Authorized Official

Name: TERRY O'CALLAGHAN
Title or Position: PRACTICE ADMINISTRATOR
Credential:
Phone: 978-745-6601