Healthcare Provider Details

I. General information

NPI: 1578769261
Provider Name (Legal Business Name): OTOLARYNGOLOGY HEAD & NECK CONSULTANTS, P.C.
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 06/21/2007
Last Update Date: 09/19/2013
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

6505 MARKET ST STE A103
YOUNGSTOWN OH
44512-3400
US

IV. Provider business mailing address

6505 MARKET ST STE A103
YOUNGSTOWN OH
44512-3400
US

V. Phone/Fax

Practice location:
  • Phone: 330-758-2001
  • Fax: 330-726-3577
Mailing address:
  • Phone: 330-758-2001
  • Fax: 330-726-3577

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207YS0123X
TaxonomyFacial Plastic Surgery Physician
License Number
License Number State

VIII. Authorized Official

Name: RICHARD D GENTILE
Title or Position: PRESIDENT
Credential: MD
Phone: 330-758-2001