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General NPI Number Information
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NPI Number | 1003849720
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Entity Type | Organization
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Legal Business Name | COMMONWEALTH EAR, NOSE & THROAT ASSOCIATES, LLC
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Dates
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Enumeration Date | 07/08/2006
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Last Update Date | 05/06/2009
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Provider Practice Location Address
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Address Line | 2280 OPITZ BLVD SUITE 340
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City | WOODBRIDGE
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State | VA
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Zip | 22191
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Country | US
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Telephone | 703-878-0777
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Fax | 703-583-1777
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Provider Business Mailing Address
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Address Line | 2280 OPITZ BLVD SUITE 340
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City | WOODBRIDGE
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State | VA
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Zip | 22191
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Country | US
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Telephone | 703-878-0777
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Fax | 703-583-1777
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Authorized Official
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Title or Position | OFFICE MANAGER
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Name | MS. CAROL J EKINS
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Credential |
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Telephone | 703-878-0777
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 207Y00000X
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Taxonomy Name | Otolaryngology Physician
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License Number |
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License Number State |
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