Provider Demographics
NPI:1992352033
Name:PRINCE GEORGES ENT HEAD & NECK SURGERY, LLC
Entity type:Organization
Organization Name:PRINCE GEORGES ENT HEAD & NECK SURGERY, LLC
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:BRYAN
Authorized Official - Middle Name:CHINAEMEREM
Authorized Official - Last Name:EGO-OSUALA
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:202-999-8413
Mailing Address - Street 1:1100 MERCANTILE LN STE 136
Mailing Address - Street 2:
Mailing Address - City:UPPR MARLBORO
Mailing Address - State:MD
Mailing Address - Zip Code:20774-5367
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:10 SAINT PATRICKS DR
Practice Address - Street 2:
Practice Address - City:WALDORF
Practice Address - State:MD
Practice Address - Zip Code:20603-4527
Practice Address - Country:US
Practice Address - Phone:301-373-7900
Practice Address - Fax:301-373-6900
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2019-08-22
Last Update Date:2020-11-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207Y00000XAllopathic & Osteopathic PhysiciansOtolaryngologyGroup - Single Specialty