=====================================================
General NPI Number Information
=====================================================
NPI Number | 1568492858
-----------------------------------------------------
Entity Type | Organization
-----------------------------------------------------
Legal Business Name | EAR, NOSE, AND THROAT ASSOCIATES OF NORTHWESTERN PENNSYLVANIA
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 07/03/2006
-----------------------------------------------------
Last Update Date | 09/11/2025
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | TWO PARK WAY
-----------------------------------------------------
City | SENECA
-----------------------------------------------------
State | PA
-----------------------------------------------------
Zip | 16346
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 814-677-6381
-----------------------------------------------------
Fax | 814-677-6384
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | PO BOX 545
-----------------------------------------------------
City | SENECA
-----------------------------------------------------
State | PA
-----------------------------------------------------
Zip | 16346-0545
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 814-677-6381
-----------------------------------------------------
Fax | 814-677-6384
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position | OWNER
-----------------------------------------------------
Name | MARC D MASLOV
-----------------------------------------------------
Credential |
-----------------------------------------------------
Telephone | 814-677-6381
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 207Y00000X
-----------------------------------------------------
Taxonomy Name | Otolaryngology Physician
-----------------------------------------------------
License Number | MD045086E
-----------------------------------------------------
License Number State | PA
-----------------------------------------------------
Taxonomy #2
-----------------------------------------------------
Taxonomy Code | 291U00000X
-----------------------------------------------------
Taxonomy Name | Clinical Medical Laboratory
-----------------------------------------------------
License Number | 025111
-----------------------------------------------------
License Number State | PA
-----------------------------------------------------
Taxonomy #3
-----------------------------------------------------
Taxonomy Code | 231H00000X
-----------------------------------------------------
Taxonomy Name | Audiologist
-----------------------------------------------------
License Number | AT000043L
-----------------------------------------------------
License Number State | PA
-----------------------------------------------------
Taxonomy #4
-----------------------------------------------------
Taxonomy Code | 231H00000X
-----------------------------------------------------
Taxonomy Name | Audiologist
-----------------------------------------------------
License Number | AT000767L
-----------------------------------------------------
License Number State | PA
-----------------------------------------------------
Taxonomy #5
-----------------------------------------------------
Taxonomy Code | 231H00000X
-----------------------------------------------------
Taxonomy Name | Audiologist
-----------------------------------------------------
License Number | AT001170L
-----------------------------------------------------
License Number State | PA
-----------------------------------------------------