Healthcare Provider Details

I. General information

NPI: 1720023351
Provider Name (Legal Business Name): WARREN OTOLOGIC GROUP, INC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 06/18/2006
Last Update Date: 05/16/2017
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3893 E MARKET ST
WARREN OH
44484-4706
US

IV. Provider business mailing address

3893 E MARKET ST
WARREN OH
44484-4706
US

V. Phone/Fax

Practice location:
  • Phone: 330-856-4000
  • Fax: 330-609-9910
Mailing address:
  • Phone: 330-856-4000
  • Fax: 330-609-9910

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code207KA0200X
TaxonomyAllergy Physician
License Number
License Number StateOH
# 2
Primary TaxonomyN
Taxonomy Code207YX0901X
TaxonomyOtology & Neurotology Physician
License Number
License Number StateOH
# 3
Primary TaxonomyY
Taxonomy Code207Y00000X
TaxonomyOtolaryngology Physician
License Number
License Number StateOH

VIII. Authorized Official

Name: DR. WILLIAM H LIPPY
Title or Position: PRESIDENT
Credential: MD
Phone: 330-856-4000