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General NPI Number Information
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NPI Number | 1497796411
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Entity Type | Organization
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Legal Business Name | CAMBRIDGE ENT AND ALLERGY CLINIC, INC.
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Dates
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Enumeration Date | 06/09/2006
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Last Update Date | 08/22/2020
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Provider Practice Location Address
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Address Line | 813 STEUBENVILLE AVE
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City | CAMBRIDGE
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State | OH
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Zip | 43725-2383
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Country | US
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Telephone | 740-439-3800
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Fax |
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Provider Business Mailing Address
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Address Line | 813 STEUBENVILLE AVE
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City | CAMBRIDGE
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State | OH
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Zip | 43725
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Country | US
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Telephone | 740-439-3800
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Fax |
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Authorized Official
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Title or Position | PRESIDENT, CEO
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Name | DR. JOHN BERNARD GHOLL
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Credential | M.D.
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Telephone | 740-439-3800
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 261QM2500X
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Taxonomy Name | Medical Specialty Clinic/Center
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License Number | 35-08-2261-G
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License Number State | OH
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