Healthcare Provider Details

I. General information

NPI: 1952372237
Provider Name (Legal Business Name): GREENSBORO EAR NOSE & THROAT ASSOCIATES PA
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 01/27/2006
Last Update Date: 07/01/2010
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1132 N CHURCH ST SUITE 200
GREENSBORO NC
27401-1039
US

IV. Provider business mailing address

1132 N CHURCH ST SUITE 200
GREENSBORO NC
27401-1039
US

V. Phone/Fax

Practice location:
  • Phone: 336-358-4268
  • Fax: 336-544-7180
Mailing address:
  • Phone: 336-358-4268
  • Fax: 336-544-7180

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207Y00000X
TaxonomyOtolaryngology Physician
License Number39952
License Number StateNC

VIII. Authorized Official

Name: MR. JEFRY H ROSEN I
Title or Position: TREASURER
Credential: MD
Phone: 336-358-4268