Provider Demographics
NPI:1447538996
Name:ANDOVER EAR, NOSE & THROAT CTR, LLC
Entity type:Organization
Organization Name:ANDOVER EAR, NOSE & THROAT CTR, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:WILLIAM
Authorized Official - Middle Name:S
Authorized Official - Last Name:POSTAL
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:978-685-7550
Mailing Address - Street 1:198 MASSACHUSETTS AVE
Mailing Address - Street 2:#103
Mailing Address - City:NORTH ANDOVER
Mailing Address - State:MA
Mailing Address - Zip Code:01845-4143
Mailing Address - Country:US
Mailing Address - Phone:978-685-7550
Mailing Address - Fax:
Practice Address - Street 1:198 MASSACHUSETTS AVE
Practice Address - Street 2:#103
Practice Address - City:NORTH ANDOVER
Practice Address - State:MA
Practice Address - Zip Code:01845-4143
Practice Address - Country:US
Practice Address - Phone:978-685-7550
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2011-08-02
Last Update Date:2011-08-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207Y00000XAllopathic & Osteopathic PhysiciansOtolaryngologyGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
MA110072121/AMedicaid
NHANDO 040514OtherBC/BS NEW HAMPSHIRE
MAM15965OtherMASSACHUSETTS BC/BS
MA110072121/AMedicaid