Provider Demographics
NPI:1194779215
Name:ADVANCED OTOLARYNGOLOGY PC
Entity type:Organization
Organization Name:ADVANCED OTOLARYNGOLOGY PC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRACTICE MANAGER
Authorized Official - Prefix:DR
Authorized Official - First Name:MICHAEL
Authorized Official - Middle Name:
Authorized Official - Last Name:ARMSTRONG
Authorized Official - Suffix:JR
Authorized Official - Credentials:MD
Authorized Official - Phone:804-330-5501
Mailing Address - Street 1:8700 STONY POINT PKWY
Mailing Address - Street 2:
Mailing Address - City:RICHMOND
Mailing Address - State:VA
Mailing Address - Zip Code:23235-1968
Mailing Address - Country:US
Mailing Address - Phone:804-330-5501
Mailing Address - Fax:804-272-4504
Practice Address - Street 1:8700 STONY POINT PKWY
Practice Address - Street 2:
Practice Address - City:RICHMOND
Practice Address - State:VA
Practice Address - Zip Code:23235-1968
Practice Address - Country:US
Practice Address - Phone:804-330-5501
Practice Address - Fax:804-272-4504
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-05-22
Last Update Date:2022-07-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA174400000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes174400000XOther Service ProvidersSpecialistGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
VAC07065Medicare PIN