Healthcare Provider Details

I. General information

NPI: 1457705717
Provider Name (Legal Business Name): ADVANCED OTOLARYNGOLOGY & ALLERGY LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 04/22/2016
Last Update Date: 02/03/2026
Certification Date: 02/03/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

864 BROADWAY STE 101
HANOVER PA
17331-1501
US

IV. Provider business mailing address

864 BROADWAY
HANOVER PA
17331-1501
US

V. Phone/Fax

Practice location:
  • Phone: 717-632-5050
  • Fax: 717-965-7519
Mailing address:
  • Phone: 717-632-5050
  • Fax: 717-965-7519

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207Y00000X
TaxonomyOtolaryngology Physician
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code207YS0123X
TaxonomyFacial Plastic Surgery Physician
License Number
License Number State
# 3
Primary TaxonomyN
Taxonomy Code261QH0700X
TaxonomyHearing and Speech Clinic/Center
License Number
License Number State
# 4
Primary TaxonomyN
Taxonomy Code261QM1300X
TaxonomyMulti-Specialty Clinic/Center
License Number
License Number State
# 5
Primary TaxonomyN
Taxonomy Code261QU0200X
TaxonomyUrgent Care Clinic/Center
License Number
License Number State

VIII. Authorized Official

Name: ZAHER SROUR
Title or Position: MD
Credential:
Phone: 717-632-2221