Provider Demographics
NPI:1285613513
Name:PIEDMONT OTOLARYNGOLOGY, PLC
Entity type:Organization
Organization Name:PIEDMONT OTOLARYNGOLOGY, PLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:PAIGE
Authorized Official - Middle Name:L
Authorized Official - Last Name:POWERS
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:434-220-0045
Mailing Address - Street 1:199 SPOTNAP RD
Mailing Address - Street 2:SUITE 5
Mailing Address - City:CHARLOTTESVILLE
Mailing Address - State:VA
Mailing Address - Zip Code:22911-8827
Mailing Address - Country:US
Mailing Address - Phone:434-220-0045
Mailing Address - Fax:434-220-0065
Practice Address - Street 1:199 SPOTNAP RD
Practice Address - Street 2:SUITE 5
Practice Address - City:CHARLOTTESVILLE
Practice Address - State:VA
Practice Address - Zip Code:22911-8827
Practice Address - Country:US
Practice Address - Phone:434-220-0045
Practice Address - Fax:434-220-0065
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-01-13
Last Update Date:2008-06-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207YX0007XAllopathic & Osteopathic PhysiciansOtolaryngologyPlastic Surgery within the Head & NeckGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
VADE0056OtherMEDICARE PIN
VAC09128Medicare PIN