Healthcare Provider Details

I. General information

NPI: 1205122793
Provider Name (Legal Business Name): CENTRAL ENT CONSULTANTS, PC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 06/22/2011
Last Update Date: 11/02/2011
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1800 DUAL HWY SUITE 303
HAGERSTOWN MD
21740-6602
US

IV. Provider business mailing address

1800 DUAL HWY SUITE 303
HAGERSTOWN MD
21740-6602
US

V. Phone/Fax

Practice location:
  • Phone: 301-739-0400
  • Fax: 301-739-0402
Mailing address:
  • Phone: 301-739-0400
  • Fax: 301-739-0402

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207Y00000X
TaxonomyOtolaryngology Physician
License NumberH0064647
License Number StateMD

VIII. Authorized Official

Name: KIRBY J SCOTT
Title or Position: OWNER
Credential: D.O.
Phone: 301-739-0400