Organization
LOCK HAVEN EAR NOSE & THROAT PC
Active
Organization subpart
No
Provider details
NPI number
Authorized official
DR. CHARLES KENNETH FOULSHAM II MD (PRESIDENT)
(570) 748-6777
Entity
Organization
Contact information
Practice address
401 HIGH STREET, LOCK HAVEN, PA 17745-0117
(570) 748-6777
(570) 748-0110
Mailing address
PO BOX 117, 401 HIGH STREET, LOCK HAVEN, PA 17745-0117
(570) 748-6777
(570) 748-0110
Taxonomy
Speciality
Code
Description
License number
State
207Y00000X
Otolaryngology Physician
Primary
MD026474E
PA
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
001030532
—
PA
01
—
058467
BLUE CROSS BLUE SHIELD
PA
01
—
186393205
GEISINGER HEALTH PLAN
PA
01
—
1943384
PENNSYLVANIA BLUE SHIELD
PA
Enumeration date
01/25/2007
Last updated
11/11/2008
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