Healthcare Provider Details

I. General information

NPI: 1811199847
Provider Name (Legal Business Name): ANDOVER EAR, NOSE AND THROAT CENTER
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 06/01/2007
Last Update Date: 08/22/2020
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

198 MASSACHUSETTS AVE #103
NORTH ANDOVER MA
01845-4143
US

IV. Provider business mailing address

198 MASSACHUSETTS AVE #103
NORTH ANDOVER MA
01845-4143
US

V. Phone/Fax

Practice location:
  • Phone: 978-685-7550
  • Fax: 978-686-5565
Mailing address:
  • Phone: 978-685-7550
  • Fax: 978-686-5565

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code261QH0700X
TaxonomyHearing and Speech Clinic/Center
License Number3745
License Number StateMA

VIII. Authorized Official

Name: DR. WILLIAM S POSTAL
Title or Position: PRESIDENT
Credential: M.D.
Phone: 978-685-7550