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General NPI Number Information
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NPI Number | 1740586197
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Entity Type | Organization
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Legal Business Name | EAR NOSE & THROAT ASSOCIATES PC
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Dates
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Enumeration Date | 02/02/2011
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Last Update Date | 02/14/2012
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Provider Practice Location Address
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Address Line | 7001 HERITAGE VILLAGE PLZ SUITE 260
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City | GAINESVILLE
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State | VA
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Zip | 20155-3065
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Country | US
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Telephone | 703-468-2205
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Fax | 703-468-2216
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Provider Business Mailing Address
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Address Line | 7001 HERITAGE VILLAGE PLZ SUITE 260
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City | GAINESVILLE
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State | VA
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Zip | 20155-3065
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Country | US
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Telephone | 703-468-2205
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Fax | 703-468-2216
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Authorized Official
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Title or Position | OFFICE MANAGER
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Name | MELANIE Y. CHUSING
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Credential |
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Telephone | 703-468-2205
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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 | 0101236105
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License Number State | VA
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