Basic Information
| Provider Information | |||||||||
| NPI: | 1134526429 | ||||||||
| EntityType: | 2 | ||||||||
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| OrganizationName: | NORTH SHORE EAR, NOSE & THROAT | ||||||||
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| Mailing Information | |||||||||
| Address1: | 104 ENDICOTT ST | ||||||||
| Address2: | SUIRE 100 | ||||||||
| City: | DANVERS | ||||||||
| State: | MA | ||||||||
| PostalCode: | 019233623 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 9787456601 | ||||||||
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| Practice Location | |||||||||
| Address1: | 104 ENDICOTT ST | ||||||||
| Address2: | SUIRE 100 | ||||||||
| City: | DANVERS | ||||||||
| State: | MA | ||||||||
| PostalCode: | 019233623 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 9787456601 | ||||||||
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| Other Information | |||||||||
| ProviderEnumerationDate: | 12/02/2014 | ||||||||
| LastUpdateDate: | 12/29/2021 | ||||||||
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| AuthorizedOfficialLastName: | MUGGE | ||||||||
| AuthorizedOfficialFirstName: | RICHARD | ||||||||
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| AuthorizedOfficialTitleorPosition: | TREASURER | ||||||||
| AuthorizedOfficialTelephone: | 9787456601 | ||||||||
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| IsOrganizationSubpart: | N | ||||||||
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| AuthorizedOfficialNamePrefix: | DR. | ||||||||
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| AuthorizedOfficialCredential: | M.D. | ||||||||
| NPICertificationDate: | 12/29/2021 | ||||||||
Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 207YS0123X | 229239 | MA | Y | 193400000X SINGLE SPECIALTY GROUP | Allopathic & Osteopathic Physicians | Otolaryngology | Facial Plastic Surgery |
No ID Information.