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General NPI Number Information
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NPI Number | 1437538154
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Entity Type | Organization
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Legal Business Name | EAR, NOSE & THROAT LTD
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Dates
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Enumeration Date | 05/27/2015
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Last Update Date | 05/27/2015
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Provider Practice Location Address
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Address Line | 901 HAMPTON BLVD
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City | NORFOLK
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State | VA
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Zip | 23507-1503
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Country | US
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Telephone | 757-623-0526
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Fax | 757-636-9090
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Provider Business Mailing Address
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Address Line | 901 HAMPTON BLVD
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City | NORFOLK
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State | VA
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Zip | 23507-1503
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Country | US
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Telephone | 757-623-0526
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Fax | 757-636-9090
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Authorized Official
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Title or Position | ADMINISTRATOR
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Name | MS. CATHERINE LAGO
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Credential |
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Telephone | 757-623-0526
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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 | 0101038741
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License Number State | VA
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