# NORTH BAY ENT & AUDIOLOGY GROUP LLC

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- **Entity:** Organization
- **Status:** Active
- **Organization subpart:** No

## Provider details

- **NPI number:** 1073316485
- **Authorized official:** LISA MALVASO (ADMINISTRATOR)
- **Authorized official phone:** (410) 879-9100

## Contact information

- **Practice address:** 456 ALLIANCE ST, HAVRE DE GRACE, MD 21078-3559
- **Practice address phone:** (410) 939-1819
- **Mailing address:** 520 UPPER CHESAPEAKE DR, BEL AIR, MD 21014-4339
- **Mailing address phone:** (410) 879-9100
- **Mailing address fax:** (410) 638-0408

## Taxonomy

| Code | Description | License number | State | Primary |
| --- | --- | --- | --- | --- |
| 207Y00000X | Otolaryngology Physician | — | NULL | Yes |
| 207Y00000X | Otolaryngology Physician | — | — | Yes |

## Other

- **Enumeration date:** 03/31/2025
- **Last updated:** 03/31/2025