Provider Demographics
NPI:1285620609
Name:EAR, NOSE & THROAT ASSOCIATES OF WORCESTER, INC.
Entity type:Organization
Organization Name:EAR, NOSE & THROAT ASSOCIATES OF WORCESTER, INC.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:CHRISTOPHER
Authorized Official - Middle Name:C
Authorized Official - Last Name:CHARON
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:508-791-6305
Mailing Address - Street 1:PO BOX 60678
Mailing Address - Street 2:
Mailing Address - City:WORCESTER
Mailing Address - State:MA
Mailing Address - Zip Code:01606-0678
Mailing Address - Country:US
Mailing Address - Phone:508-791-6305
Mailing Address - Fax:508-791-6309
Practice Address - Street 1:246 SOUTHBRIDGE RD
Practice Address - Street 2:
Practice Address - City:CHARLTON
Practice Address - State:MA
Practice Address - Zip Code:01507-5237
Practice Address - Country:US
Practice Address - Phone:508-980-7074
Practice Address - Fax:508-434-0821
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2005-09-21
Last Update Date:2022-04-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
207Y00000X, 231H00000X, 231HA2400X, 363L00000X, 207Y00000X
MA35288208600000X
CT237231H00000X
MA1029231H00000X
MA703231HA2400X
MA893231HA2400X
CT197231HA2400X
MA35390207Y00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207Y00000XAllopathic & Osteopathic PhysiciansOtolaryngologyGroup - Multi-Specialty
No231H00000XSpeech, Language and Hearing Service ProvidersAudiologistGroup - Multi-Specialty
No231HA2400XSpeech, Language and Hearing Service ProvidersAudiologistAssistive Technology PractitionerGroup - Multi-Specialty
No363L00000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerGroup - Multi-Specialty
No208600000XAllopathic & Osteopathic PhysiciansSurgeryGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
CT003119288Medicaid
CT008049047Medicaid
MA110006406AMedicaid
MA110034711AMedicaid
MA3100227Medicaid
CT003119270Medicaid
MA110034395AMedicaid
MA110068031AMedicaid
MA110006406AMedicaid
MAM12695Medicare PIN
MA110034711AMedicaid
CTC01719Medicare PIN
CTD400071195Medicare PIN
MAN01592Medicare PIN
MA029364Medicare PIN
CT008049047Medicaid
MAN01618Medicare PIN
CT003119288Medicaid
MA110068031AMedicaid
MAN01584Medicare PIN
MAA35959Medicare PIN