Healthcare Provider Details

I. General information

NPI: 1760579106
Provider Name (Legal Business Name): EAR NOSE & THROAT LTD
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 10/06/2006
Last Update Date: 05/20/2021
Certification Date: 05/20/2021
Deactivation Date:
Reactivation Date:

III. Provider practice location address

885 KEMPSVILLE RD STE 221
NORFOLK VA
23502-3800
US

IV. Provider business mailing address

885 KEMPSVILLE RD STE 221
NORFOLK VA
23502-3800
US

V. Phone/Fax

Practice location:
  • Phone: 757-623-0526
  • Fax: 757-623-0609
Mailing address:
  • Phone: 757-623-0526
  • Fax: 757-623-0609

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 State

VIII. Authorized Official

Name: DR. JOHN THOMAS KALAFSKY
Title or Position: PRESIDENT
Credential: M.D.
Phone: 757-623-0526