Provider Demographics
NPI:1538213715
Name:HAGERSTOWN EAR NOSE & THROAT ASSOCIATES
Entity type:Organization
Organization Name:HAGERSTOWN EAR NOSE & THROAT ASSOCIATES
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:BIBHAS
Authorized Official - Middle Name:C
Authorized Official - Last Name:BANDY
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:301-790-0444
Mailing Address - Street 1:363 S CLEVELAND AVE
Mailing Address - Street 2:SUITE 202
Mailing Address - City:HAGERSTOWN
Mailing Address - State:MD
Mailing Address - Zip Code:21740-5747
Mailing Address - Country:US
Mailing Address - Phone:301-790-0444
Mailing Address - Fax:301-739-3275
Practice Address - Street 1:363 S CLEVELAND AVE
Practice Address - Street 2:SUITE 202
Practice Address - City:HAGERSTOWN
Practice Address - State:MD
Practice Address - Zip Code:21740-5747
Practice Address - Country:US
Practice Address - Phone:301-790-0444
Practice Address - Fax:301-739-3275
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-01-23
Last Update Date:2008-10-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MDD0015485207Y00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207Y00000XAllopathic & Osteopathic PhysiciansOtolaryngologyGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
221028OtherMAMSI HEALTH PLANS
08357440005OtherCIGNA
E4250001OtherFEDERAL BLUE SHIELD
041923465AOtherTRAVELERS MEDICARE
MD910951000Medicaid
C043OtherCAREFIRS BCBS
08357440005OtherCIGNA
MD910951000Medicaid