Healthcare Provider Details

I. General information

NPI: 1053358952
Provider Name (Legal Business Name): EAR, NOSE AND THROAT ASSOCIATES OF CHESTER COUNTY
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 05/31/2006
Last Update Date: 07/21/2022
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

111 ARRANDALE BLVD
EXTON PA
19341
US

IV. Provider business mailing address

111 ARRANDALE BLVD
EXTON PA
19341
US

V. Phone/Fax

Practice location:
  • Phone: 610-363-2532
  • Fax: 610-363-0210
Mailing address:
  • Phone: 610-363-2532
  • Fax: 610-363-0210

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207YX0007X
TaxonomyPlastic Surgery within the Head & Neck (Otolaryngology) Physician
License Number
License Number StatePA

VII. Legacy identifiers

For crosswalk purposes, the following legacy (non-NPI) identifiers are available for this provider:

# 1
Identifier1007761530001
Identifier TypeMEDICAID
Identifier StatePA
Identifier Issuer

VIII. Authorized Official

Name: DEANNA DIMASCIO
Title or Position: PRACTICE ADMINISTRATOR
Credential:
Phone: 610-363-2532