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General NPI Number Information
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NPI Number | 1295786465
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Entity Type | Organization
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Legal Business Name | COLDEN EAR NOSE THROAT & ALLERGY LLC
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Dates
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Enumeration Date | 05/13/2006
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Last Update Date | 02/25/2025
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Provider Practice Location Address
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Address Line | 1 WALLACE BASHAW JR. WAY SUITE 3002
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City | NEWBURYPORT
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State | MA
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Zip | 01950-3875
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Country | US
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Telephone | 978-997-1550
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Fax | 978-499-8200
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Provider Business Mailing Address
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Address Line | 1 WALLACE BASHAW JR. WAY SUITE 3002
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City | NEWBURYPORT
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State | MA
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Zip | 01950-3875
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Country | US
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Telephone | 978-997-1550
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Fax | 978-499-8200
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Authorized Official
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Title or Position | PRACTICE MGR.
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Name | CRISSY L. OLSON
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Credential |
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Telephone | 978-947-1550
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 207YX0905X
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Taxonomy Name | Otolaryngology/Facial Plastic Surgery Physician
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License Number |
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License Number State |
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Taxonomy #2
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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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