Organization
EAR NOSE & THROAT ASSC OF CHARL INC
Active
Organization subpart
No
Provider details
NPI number
Authorized official
MR. FREDERICK THOMAS SPORCK MD (PHYSICIAN DIRECTOR)
(304) 340-2225
Entity
Organization
Contact information
Practice address
500 DONNALLY ST, SUITE 200, CHARLESTON, WV 25301-1648
(304) 342-0124
(304) 340-2204
Mailing address
PO BOX 1628, CHARLESTON, WV 25326-1628
(304) 340-2225
(304) 340-2204
Taxonomy
Speciality
Code
Description
License number
State
207Y00000X
Otolaryngology Physician
Primary
—
WV
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
0008888000
—
WV
01
—
0778148001
CIGNA
WV
01
—
CA7089
RR MEDICARE
WV
Enumeration date
07/26/2005
Last updated
07/21/2022
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