Healthcare Provider Details

I. General information

NPI: 1710932629
Provider Name (Legal Business Name): WILMINGTON EAR NOSE & THROAT ASSOC., P.A.
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 05/23/2006
Last Update Date: 06/05/2019
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2311 DELANEY RD
WILMINGTON NC
28403-6012
US

IV. Provider business mailing address

2311 DELANEY RD
WILMINGTON NC
28403-6012
US

V. Phone/Fax

Practice location:
  • Phone: 910-762-8754
  • Fax: 910-762-0778
Mailing address:
  • Phone: 910-762-8754
  • Fax: 910-762-0778

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code174400000X
TaxonomySpecialist
License Number
License Number StateNC
# 2
Primary TaxonomyN
Taxonomy Code207Y00000X
TaxonomyOtolaryngology Physician
License Number
License Number State

VIII. Authorized Official

Name: BRANDON TODD
Title or Position: OFFICE ADMINISTRATOR
Credential:
Phone: 910-762-8754