Provider Demographics
NPI:1245661222
Name:HAMPTON ROADS OTOLARYNGOLOGY ASSOCIATES
Entity type:Organization
Organization Name:HAMPTON ROADS OTOLARYNGOLOGY ASSOCIATES
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:PRACTICE ADMINISTRATOR
Authorized Official - Prefix:
Authorized Official - First Name:CATHERINE
Authorized Official - Middle Name:
Authorized Official - Last Name:TRAISTER
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:757-873-0338
Mailing Address - Street 1:5408 DISCOVERY PARK BLVD
Mailing Address - Street 2:SUITE 300
Mailing Address - City:WILLIAMSBURG
Mailing Address - State:VA
Mailing Address - Zip Code:23188-2893
Mailing Address - Country:US
Mailing Address - Phone:757-253-8872
Mailing Address - Fax:
Practice Address - Street 1:5408 DISCOVERY PARK BLVD
Practice Address - Street 2:SUITE 300
Practice Address - City:WILLIAMSBURG
Practice Address - State:VA
Practice Address - Zip Code:23188-2893
Practice Address - Country:US
Practice Address - Phone:757-253-8872
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:HAMPTON ROADS OTOLARYNGOLOGY ASSOCIATES
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2013-12-02
Last Update Date:2013-12-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes332900000XSuppliersNon-Pharmacy Dispensing Site