Healthcare Provider Details

I. General information

NPI: 1437538154
Provider Name (Legal Business Name): EAR, NOSE & THROAT LTD
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 05/27/2015
Last Update Date: 05/27/2015
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

901 HAMPTON BLVD
NORFOLK VA
23507-1503
US

IV. Provider business mailing address

901 HAMPTON BLVD
NORFOLK VA
23507-1503
US

V. Phone/Fax

Practice location:
  • Phone: 757-623-0526
  • Fax: 757-636-9090
Mailing address:
  • Phone: 757-623-0526
  • Fax: 757-636-9090

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207Y00000X
TaxonomyOtolaryngology Physician
License Number0101038741
License Number StateVA

VIII. Authorized Official

Name: MS. CATHERINE LAGO
Title or Position: ADMINISTRATOR
Credential:
Phone: 757-623-0526