Healthcare Provider Details

I. General information

NPI: 1295786465
Provider Name (Legal Business Name): COLDEN EAR NOSE THROAT & ALLERGY LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 05/13/2006
Last Update Date: 02/25/2025
Certification Date: 02/25/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1 WALLACE BASHAW JR. WAY SUITE 3002
NEWBURYPORT MA
01950-3875
US

IV. Provider business mailing address

1 WALLACE BASHAW JR. WAY SUITE 3002
NEWBURYPORT MA
01950-3875
US

V. Phone/Fax

Practice location:
  • Phone: 978-997-1550
  • Fax: 978-499-8200
Mailing address:
  • Phone: 978-997-1550
  • Fax: 978-499-8200

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code207YX0905X
TaxonomyOtolaryngology/Facial Plastic Surgery Physician
License Number
License Number State
# 2
Primary TaxonomyY
Taxonomy Code207Y00000X
TaxonomyOtolaryngology Physician
License Number
License Number State

VIII. Authorized Official

Name: CRISSY L. OLSON
Title or Position: PRACTICE MGR.
Credential:
Phone: 978-947-1550