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General NPI Number Information
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NPI Number | 1386344331
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Entity Type | Organization
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Legal Business Name | MARTHAS VINEYARD EAR NOSE AND THROAT SPECIALISTS PC
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Dates
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Enumeration Date | 03/08/2023
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Last Update Date | 03/08/2023
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Provider Practice Location Address
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Address Line | 20 INDIAN HILL RD
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City | WEST TISBURY
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State | MA
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Zip | 02575
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Country | US
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Telephone | 508-367-7131
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Fax |
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Provider Business Mailing Address
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Address Line | 60 MEETING HOUSE RD
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City | CHILMARK
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State | MA
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Zip | 02535-2517
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Country | US
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Telephone | 508-648-9468
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Fax |
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Authorized Official
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Title or Position | PRESIDENT
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Name | EDWARD CALDWELL
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Credential | MD
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Telephone | 508-648-9468
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 207YS0012X
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Taxonomy Name | Sleep Medicine (Otolaryngology) 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 | 207YS0123X
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Taxonomy Name | Facial Plastic Surgery Physician
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License Number |
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License Number State |
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