Provider Demographics
NPI:1073316485
Name:NORTH BAY ENT & AUDIOLOGY GROUP LLC
Entity type:Organization
Organization Name:NORTH BAY ENT & AUDIOLOGY GROUP LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:ADMINISTRATOR
Authorized Official - Prefix:
Authorized Official - First Name:LISA
Authorized Official - Middle Name:
Authorized Official - Last Name:MALVASO
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:410-879-9100
Mailing Address - Street 1:520 UPPER CHESAPEAKE DR
Mailing Address - Street 2:
Mailing Address - City:BEL AIR
Mailing Address - State:MD
Mailing Address - Zip Code:21014-4339
Mailing Address - Country:US
Mailing Address - Phone:410-879-9100
Mailing Address - Fax:410-638-0408
Practice Address - Street 1:456 ALLIANCE ST
Practice Address - Street 2:
Practice Address - City:HAVRE DE GRACE
Practice Address - State:MD
Practice Address - Zip Code:21078-3559
Practice Address - Country:US
Practice Address - Phone:410-939-1819
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2025-03-31
Last Update Date:2025-03-31
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207Y00000XAllopathic & Osteopathic PhysiciansOtolaryngologyGroup - Single Specialty