Organization
EAR,NOSE AND THROAT OF WARREN, INC.
Active
Organization subpart
No
Provider details
NPI number
Authorized official
EWAIN WILSON M.D. (DIRECTOR)
(330) 609-8430
Entity
Organization
Contact information
Practice address
628 NILES CORTLAND RD SE, SUITE 103, WARREN, OH 44484-2473
(330) 609-8430
(133) 031-5753
Mailing address
628 NILES CORTLAND RD SE, SUITE 103, WARREN, OH 44484-2473
(330) 609-8430
(133) 031-5754
Taxonomy
Speciality
Code
Description
License number
State
207Y00000X
Otolaryngology Physician
Primary
35.091822
OH
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
00000579715
ANTHEM
OH
Enumeration date
08/11/2008
Last updated
07/21/2009
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