Provider Demographics
NPI:1316336225
Name:EAR NOSE & THROAT OF THE UPPER MAIN LINE LLC
Entity type:Organization
Organization Name:EAR NOSE & THROAT OF THE UPPER MAIN LINE LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PHYSICIAN
Authorized Official - Prefix:DR
Authorized Official - First Name:JOSEPH
Authorized Official - Middle Name:M
Authorized Official - Last Name:ARDITO
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:610-296-5600
Mailing Address - Street 1:15 INDUSTRIAL BLVD
Mailing Address - Street 2:SUITE 102
Mailing Address - City:PAOLI
Mailing Address - State:PA
Mailing Address - Zip Code:19301-1608
Mailing Address - Country:US
Mailing Address - Phone:610-296-5600
Mailing Address - Fax:610-296-3308
Practice Address - Street 1:15 INDUSTRIAL BLVD
Practice Address - Street 2:SUITE 102
Practice Address - City:PAOLI
Practice Address - State:PA
Practice Address - Zip Code:19301-1608
Practice Address - Country:US
Practice Address - Phone:610-296-5600
Practice Address - Fax:610-296-3308
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:EAR NOSE & THROAT OF THE UPPER MAIN LINE LLC
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2015-01-15
Last Update Date:2015-01-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PAMD024840E207YX0905X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207YX0905XAllopathic & Osteopathic PhysiciansOtolaryngologyOtolaryngology/Facial Plastic SurgeryGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
PAB35317Medicare UPIN