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General NPI Number Information
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NPI Number | 1740436641
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Entity Type | Organization
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Legal Business Name | EAR,NOSE AND THROAT OF WARREN, INC.
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Dates
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Enumeration Date | 08/11/2008
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Last Update Date | 07/21/2009
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Provider Practice Location Address
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Address Line | 628 NILES CORTLAND RD SE SUITE 103
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City | WARREN
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State | OH
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Zip | 44484-2473
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Country | US
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Telephone | 330-609-8430
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Fax | 133-031-5753
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Provider Business Mailing Address
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Address Line | 628 NILES CORTLAND RD SE SUITE 103
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City | WARREN
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State | OH
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Zip | 44484-2473
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Country | US
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Telephone | 330-609-8430
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Fax | 133-031-5754
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Authorized Official
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Title or Position | DIRECTOR
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Name | EWAIN WILSON
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Credential | M.D.
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Telephone | 330-609-8430
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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 | 35.091822
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License Number State | OH
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