Organization
NORTHEAST ENT
Active
Organization subpart
No
Provider details
NPI number
Authorized official
MS. DEBORAH CORNWALL (PRACTICE ADMINISTRATOR)
(508) 207-4462
Entity
Organization
Contact information
Practice address
299 FAUNCE CORNER RD, N. DARTMOUTH, MA 02747
(508) 995-0700
(508) 995-3070
Mailing address
299 FAUNCE CORNER RD, N. DARTMOUTH, MA 02747
(508) 995-0700
(508) 995-3070
Taxonomy
Speciality
Code
Description
License number
State
207YS0123X
Facial Plastic Surgery Physician
Primary
—
—
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
9773312
—
MA
Enumeration date
11/22/2006
Last updated
06/05/2013
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