=====================================================
General NPI Number Information
=====================================================
NPI Number | 1710097159
-----------------------------------------------------
Entity Type | Organization
-----------------------------------------------------
Legal Business Name | EAR NOSE & THROAT AND HEARING CENTER OF EASTERN MASSACHUSETTS PC
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 08/30/2006
-----------------------------------------------------
Last Update Date | 07/02/2008
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 61 LINCOLN ST SUITE 109
-----------------------------------------------------
City | FRAMINGHAM
-----------------------------------------------------
State | MA
-----------------------------------------------------
Zip | 01702-8264
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 508-626-8956
-----------------------------------------------------
Fax | 508-875-4103
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 1342 BELMONT ST SUITE 205
-----------------------------------------------------
City | BROCKTON
-----------------------------------------------------
State | MA
-----------------------------------------------------
Zip | 02301-4436
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 508-626-8956
-----------------------------------------------------
Fax | 508-875-4103
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position | PRESIDENT
-----------------------------------------------------
Name | DR. VICTOR E CALCATERRA
-----------------------------------------------------
Credential | MD
-----------------------------------------------------
Telephone | 508-626-8956
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 207Y00000X
-----------------------------------------------------
Taxonomy Name | Otolaryngology Physician
-----------------------------------------------------
License Number |
-----------------------------------------------------
License Number State |
-----------------------------------------------------