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General NPI Number Information
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NPI Number | 1013716802
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Entity Type | Organization
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Legal Business Name | NORTH BAY ENT & AUDIOLOGY GROUP LLC
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Dates
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Enumeration Date | 03/12/2025
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Last Update Date | 03/12/2025
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Provider Practice Location Address
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Address Line | 9114 PHILADELPHIA RD STE 108
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City | BALTIMORE
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State | MD
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Zip | 21237-4346
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Country | US
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Telephone | 410-879-9100
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Fax |
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Provider Business Mailing Address
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Address Line | 520 UPPER CHESAPEAKE DR
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City | BEL AIR
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State | MD
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Zip | 21014-4339
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Country | US
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Telephone | 410-879-9100
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Fax | 410-638-0408
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Authorized Official
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Title or Position | ADMINISTRATOR
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Name | LISA MALVASO
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Credential |
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Telephone | 410-879-9100
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 207YX0602X
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Taxonomy Name | Otolaryngic Allergy Physician
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License Number |
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License Number State |
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