Healthcare Provider Details

I. General information

NPI: 1962492090
Provider Name (Legal Business Name): GREATER MILFORD EAR NOSE AND THROAT HEAD AND NECK SURGERY INC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 10/28/2005
Last Update Date: 08/22/2020
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

42 CAPE RD
MILFORD MA
01757-3292
US

IV. Provider business mailing address

42 CAPE RD
MILFORD MA
01757-3292
US

V. Phone/Fax

Practice location:
  • Phone: 508-478-0555
  • Fax: 508-473-5088
Mailing address:
  • Phone: 508-478-0555
  • Fax: 508-473-5088

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207YX0905X
TaxonomyOtolaryngology/Facial Plastic Surgery Physician
License Number
License Number State

VIII. Authorized Official

Name: MR. JOSEPH NEIL WILSON
Title or Position: PRESIDENT
Credential: MD
Phone: 508-478-0555