Provider Demographics
NPI:1427157296
Name:LONGWOOD OTOLARYNGOLOGY
Entity type:Organization
Organization Name:LONGWOOD OTOLARYNGOLOGY
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:ROBERT
Authorized Official - Middle Name:ANDREW
Authorized Official - Last Name:FRANKENTHALER
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:617-975-2800
Mailing Address - Street 1:1223 BEACON ST
Mailing Address - Street 2:
Mailing Address - City:BROOKLINE
Mailing Address - State:MA
Mailing Address - Zip Code:02446-5302
Mailing Address - Country:US
Mailing Address - Phone:617-975-2800
Mailing Address - Fax:617-975-2825
Practice Address - Street 1:1223 BEACON ST
Practice Address - Street 2:
Practice Address - City:BROOKLINE
Practice Address - State:MA
Practice Address - Zip Code:02446-5302
Practice Address - Country:US
Practice Address - Phone:617-975-2800
Practice Address - Fax:617-975-2825
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-09-21
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MA79762207Y00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207Y00000XAllopathic & Osteopathic PhysiciansOtolaryngologyGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
MA9716891Medicaid
MAD87438Medicare UPIN
MALOM21302Medicare ID - Type Unspecified