=====================================================
General NPI Number Information
=====================================================
NPI Number | 1790183721
-----------------------------------------------------
Entity Type | Organization
-----------------------------------------------------
Legal Business Name | EAR NOSE & THROAT CONSULTANTS, INC.
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 12/08/2014
-----------------------------------------------------
Last Update Date | 12/08/2014
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 100 SYLVAN RD SUITE 750
-----------------------------------------------------
City | WOBURN
-----------------------------------------------------
State | MA
-----------------------------------------------------
Zip | 01801-1851
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 781-731-3001
-----------------------------------------------------
Fax | 781-937-3070
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 100 SYLVAN RD SUITE 750
-----------------------------------------------------
City | WOBURN
-----------------------------------------------------
State | MA
-----------------------------------------------------
Zip | 01801-1851
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 781-731-3001
-----------------------------------------------------
Fax | 781-937-3070
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position | PRESIDENT
-----------------------------------------------------
Name | JEFFREY STUART BROWN
-----------------------------------------------------
Credential | M.D.
-----------------------------------------------------
Telephone | 781-937-3001
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 207YX0602X
-----------------------------------------------------
Taxonomy Name | Otolaryngic Allergy Physician
-----------------------------------------------------
License Number |
-----------------------------------------------------
License Number State |
-----------------------------------------------------