Organization
WILMINGTON EAR NOSE & THROAT ASSOC., P.A.
Active
Organization subpart
No
Provider details
NPI number
Authorized official
BRANDON TODD (OFFICE ADMINISTRATOR)
(910) 762-8754
Entity
Organization
Contact information
Practice address
2311 DELANEY RD, WILMINGTON, NC 28403-6012
(910) 762-8754
(910) 762-0778
Mailing address
2311 DELANEY RD, WILMINGTON, NC 28403-6012
(910) 762-8754
(910) 762-0778
Taxonomy
Speciality
Code
Description
License number
State
174400000X
Specialist
Primary
—
NC
207Y00000X
Otolaryngology Physician
—
—
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
01157
BLUE CROSS GROUP NUMBER
NC
05
—
3404217
—
NC
05
—
5902912
—
NC
05
—
8901157
—
NC
01
—
CD6751
RAIL ROAD MEDICARE
NC
Enumeration date
05/23/2006
Last updated
06/05/2019
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